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Dir II GBD Quality Mgmt - Plan


Job Summary

Hanover, MD
Other/Not Classified
Job Type
Full Time
Career Level
Experienced (Non-Manager)
Job Reference Code

Dir II GBD Quality Mgmt - Plan

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.

Responsible for developing, coordinating, communicating, and implementing a strategic clinical quality management and improvement program within assigned health plan. Primary duties may include, but are not limited to:
  • Promotes broad understanding, communication, and collaboration with enterprise-wide leaders to ensure appropriate communication, integration, and utilization of best practices.
  • Oversees internal and state Quality Management (QM) Scorecard reporting.
  • Provides oversight for the member complaint, appeal process, privacy compliance process, or auditing of delegated services in assigned area.
  • Oversees Health Employer Data Information Sets (HEDIS) reporting and the development of action plans to achieve target improvement goals.
  • Supports the External Quality Review Organization (EQRO) reporting and state audit processes.
  • Provides leadership for QM representation in new business activities.
  • Ensure 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 in a health or business related field; 10 years of experience in a healthcare environment, including prior management experience; or any combination of education and experience, which would provide an equivalent background. MSN, MPH, or MPA preferred. CQM experience in a Managed Care Organization strongly preferred. Population health management and/or clinical quality program development experience 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.


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