Anthem, Inc. Regional Vice President Quality Management, Government Business Division Plan - Central Region - PS36700 in Maitland, Florida
SHIFT: Day 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.
Regional Vice President Quality Management, Government Business Division Plan - Central Region
Responsible for developing, coordinating, communicating, and implementing a strategic clinical quality management and improvement program within a Medicare region. For Medicare, is a direct report to the regional President and is responsible for quality for all Medicare products, leads directly and through corporate teams all revenue-enhancement efforts (RAF score improvement) additional initiatives and acts as subject matter expert to the other Medicare regions. Responsible for attaining high quality scores/Star ratings which can result in significant savings/revenue enhancement for the health plan.
Primary duties may include, but are not limited to:
Promotes 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) and/or CAHPS, including Value Based Purchasing (VBP) programs.
Develops strategic HEDIS, CAHPS, VBP goals and objectives, ensures timely completion and develops contingency plans as needed.
Supports the External Quality Review Organization (EQRO) reporting and state audit processes.
Provides leadership for QM representation in new business activities.
Ensures compliance with National Committee for Quality Assurance (NCQA) standards or other accrediting bodies (as applicable).
Participates on health plan and corporate QM committees and leadership meetings.
Hires, trains, coaches, counsels, and evaluates performance of direct reports.
Requires MS/MA in nursing, public health, healthcare administration, or other health care related field; 12+ years of experience in health care environment; 10 years of experience in a managed care organization QM role; 8 years of experience working with government sponsored health care programs; or any combination of education and experience, which would provide an equivalent background.
Certified Professional Healthcare Quality (CPHQ) preferred.
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.