Get new similar jobs by email for

Dir Clinical QM-NY


Job Summary

New York, NY
Other/Not Classified
Job Type
Full Time
Career Level
Experienced (Non-Manager)
Job Reference Code

Dir Clinical QM-NY

About the Job


Your Talent. Our Vision. At Anthem, Inc., it's a powerful combination, and the foundation upon which we're creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.

This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company.

This position reports to the New York health plan. Responsible for developing, coordinating, and implementing quality initiatives in the NY health plan.
Primary duties may include, but are not limited to:
  • Provides leadership for implementation of Quality Management Program for the NY Health Plan.
  • Establishes annual goals and objectives.
  • Promotes understanding, communication, and coordination of the Clinical Quality Management Program. Oversees Quality Management (QM) Scorecard reporting.
  • Provides leadership for the development, implementation, and evaluation of Clinical Quality improvement action plans.
  • Oversees the member complaint process, appeal process, and privacy compliance process.
  • Provides leadership for the member/provider satisfaction survey process. Oversees Health Employer Data Information Sets (HEDIS) reporting and the development of action plans to achieve target improvement goals.
  • Supports the Health Plans External Quality Review Organization (EQRO) state audit processes.
  • Participates in the Quality Improvement Council (QIC). Supports compliance with National Committee for Quality Assurance (NCQA) standards or other accrediting bodies.
  • Hires, trains, coaches, counsels, and evaluates performance of direct reports
  • Requires a BA/BS; 10 years of experience in quality management, risk management, and/or utilization management in a managed care setting, prior management experience; or any combination of education and experience, which would provide an equivalent background. MSN, MPH, or MPA preferred.

Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran.


Job Tools