Anthem, Inc. Remote Clinical Quality Program Administrator in Houston, Texas
SHIFT: Day Job
Job Title: Remote Clinical Quality Program Administrator Location: Work From Home / Remote (Only considering candidates residing and licensed or certified in the state of Texas)
Hours: Standard, Monday-Friday, 8:00am-5:00pm
Be part of an extraordinary team! We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact? How you will make an impact: Responsible for overseeing the quality improvement activities/projects as outlined in the Quality Improvement (QI) work plan and as required by applicable law, regulations and accreditation standards.
Primary duties may include, but are not limited to:
Ensures integration of quality into the overall business process.
Ensures that study methodology is sound and appropriate reporting is in place.
Performs assessments to identify gaps in the enterprises quality and technology assessment processes and initiates actions to correct these gaps.
Assures accuracy and completeness of input provided to internal and external QI committees and timely implementation of appropriate interventions.
Oversees the implementation of new initiatives.
Oversees quality improvement activities for the largest, most complex state programs.
Oversees the clinical quality improvement activities/projects to implement appropriate clinical interventions to improve the quality of care for members.
Assures compliance with corporate QI work plans.
Assures QI activities are relevant to the targeted population.
Assures compliance to Practice Guideline, Delegation and Continuity and Coordination of care Standards.
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 results.
May provide oversight to the Healthcare Effectiveness Data and Information Set (HEDIS) project team.
Participates in state level quality strategy meetings, develops a quality plan, and ensures integration of quality into the overall business process.
Participates in and provides input to the development of new product designs for major line of business.
Works with the clinical intervention team to design studies to identify barriers to medical interventions.
Develops performance improvement plans and oversees the clinical quality improvement activities/projects to improve the quality of care for members.
Requires a BS in health administration, nursing or related clinical field; 3 years of health care quality or data analysis experience; or any combination of education and experience, which would provide an equivalent background.
Preferred Skills, Capabilities and Experiences:
Experience in clinical quality, healthcare data analysis, JACHO/TJC (Joint Commission) is desirable.
Current unrestricted Registered Nurse (RN) license in the state of Texas, certification in applicable field (i.e. CPHQ) and/or a MS in the health field (i.e. Nursing) is preferred.
Some proficiency with Excel is preferred.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Anthem approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws. Anthem, Inc. has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact firstname.lastname@example.org for assistance.