Anthem Clinical Quality Program Manager - Georgia - 123822 in Atlanta, Georgia

/Your Talent. Our Vision/. AtBlue Cross Blue Shield of Georgia, a proud member of the Anthem, Inc. family of companies, 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 willdrive the future of health care. This is an exceptional opportunity to do innovative work that means more to you and those we serve.

Clinical Quality Program Manager

Work location: Any Anthem office in Georgia

Responsible for serving as a liaison with and overseeing the quality improvement activities/projects/programs for one or more states within a major line of business.

Primary duties may include, but are not limited to: - Leads state level quality strategy meetings, develops a quality plan, and ensures integration of quality into the overall business process. - Works with the clinical intervention team to design studies to identify barriers to medical interventions. - Ensures that study methodology is sound and appropriate reporting is in place. - Develops performance improvement plans and oversees the clinical quality improvement activities/projects to improve the quality of care for members. - Assures compliance with corporate QI work plans. - Assures that all QI activities are relevant to the needs of targeted population. - Maintains effective documentation of research programs to meet regulatory and Accreditation Standards. - Provides oversight to assure accurate and complete quantitative analysis of clinical data and presentation of data analysis results. - Participates in and provides input to the development of new product designs for major line of business. - Oversees the implementation of new initiatives. - Leads interactions with regulators or oversight entities. - Oversees quality improvement activities for the largest, most complex state programs.

  • Requires a BS in health administration, nursing, or a related clinical field;

  • 4 years of health care quality or data analysis experience; or any combination of education and experience, which would provide an equivalent background.

  • Current unrestricted license, certification in applicable field (i.e. CPHQ) and/or a MS in the health field (i.e. Nursing) is preferred.

  • Requires Excellent PC skills (i.e. Word, Access, Excel)

  • Requires strong analytical skill set as well as strong verbal, written and interpersonal communication skills.

  • Clinical quality background, auditor experience as well as NCQA or accreditation background required.

  • HEDIS experience required

/Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine, and is a 2016 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company please visit us at EOE. M/F/Disability/Veteran./

Job Medical

Title: Clinical Quality Program Manager - Georgia - 123822

Location: GA-Atlanta

Requisition ID: 123822