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Practice Consultant, HEDIS Qua...


Job Summary

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

Practice Consultant, HEDIS Quality Management - FT Employee w/benefits - Buffalo, NY - PS4298

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.

NOTE: This is not a "consultant" position. It is a FT employee w/benefits position.

This Practice Consultant position supports the Clinical Quality Management team in the WNY region, located in Buffalo, NY. The position requires local travel (approx. 75%) to providers in our network (reimbursed for mileage and tolls). You will be conducting internal audits of medical records, as well as presenting a new Provider Performance Payment Program.

The Practice Consultant is responsible for creating a partnership relationship with providers and other initiatives and implementing the concept of a Medical Home for our members to achieve this fully integrated and accountable system of care.

Primary duties may include, but are not limited to:

Assesses current practice patterns, assets and challenges utilizing Medical Home Index, NCQA Standards, HEDIS audits, site reviews and medical records reviews.

In partnership with the PCP, evaluates results of the initial assessment. Establishes a project plan with the practice that establishes goals and objectives for improvement.

Provides ongoing practice support and sustains the partnership.

Establishes regular meetings to track progress.

Identifies and facilitates at least one practice in each MPC region to become SSB Physician Champions by obtaining NCQA certification as a Patient Centered Medical Home.

Improves the understanding and sensitivity to the unique needs of this population and the care givers.


Requires an AS/BS in nursing; 5 years of managed care experience; 2 years of clinical experience; 2 years of experience doing professional presentations to small and large audiences; or any combination of education and experience, which would provide an equivalent background. BSN or MSN preferred.

-Current, unrestricted clinical license in NY (LVN/LPN, RN, NP, PA, LCSW, LSW, etc.) required.

-HEDIS knowledge required.

-Knowledge of Medicaid and the Medicaid contract preferred.

-Experience working directly with providers on a regular basis preferred.

-Must have excellent presentation skills. Prior presentation exp. preferred.

-Must have excellent written and verbal communication skills.

-Must be able to speak with providers as an influencer with professionalism and confidence!

-Able to travel locally with own vehicle (mileage and tolls reimbursed)

-Ability to act as a liaison between NY QM, corporate, network relations, etc.

-Must be able to work independently, be self-directed, organized and detail oriented.

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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