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Anthem, Inc. Director Regional Quality Management in Portland, Maine

Description

SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision. At Beacon Health Options, a proud member of the Anthem, Inc. family of companies, it’s a powerful combination. It’s 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.

For more than 30 years, Beacon Health Options has changed the way people live with behavioral health conditions. Today, we are the undisputed leader in behavioral health management, serving 37 million people across all 50 states. At Beacon, our mission is to help people live their lives to the fullest potential. Beacon offers superior clinical mental health and substance use disorder management, a comprehensive employee assistance program, work/life support, specialty programs for autism and depression, and insightful analytics to improve the delivery of care.

Director Regional Quality Management

Responsible for managing the development and execution of quality activities and processes in the Region. Typically manages 10 to 20 plans/clients within the region. Provides support and designs strategies for these plans.

Primary duties may include, but are not limited to:

  • Serves as primary interface with clients in Quality related committees including Delegation Oversight meetings and audits.

  • Produces QM documents, including tracking and updating Work Plan activity progress.

  • Implements corporate policies and creates local quality addenda and SOPs when needed.

  • Produces and oversees production of client and contractual reports and reports required for meeting accreditation standards.

  • Provides Quality thought leadership to Sales teams/RFPs, and creates quality-related articles for members and providers.

  • Ensures ongoing compliance with accreditation (NCQA and URAC) standards.

  • Assists Corporate Quality in preparation for NCQA or URAC accreditation survey.

  • Leads and/or chairs quality committees.

  • Provides monthly reports to Corporate Quality Committee (CQC) on regional quality, Utilization Management and clinical activities as well as metrics and outcomes.

  • Serves as the regional lead on Member Satisfaction survey administration and analysis in collaboration with Corporate Quality.

  • Also serves as the regional lead for the Cultural and Linguistics program.

  • Conducts quality trainings as requested by Corporate Quality.

  • May oversee and manage the complaints and grievances process for the region.

  • Leads quality performance improvement, implementation, and program development to support accreditation including developing, implementing, monitoring and tracking performance of regional quality programs.

  • Participates with Corporate Quality and other regional Quality leads in the charter of Quality

  • Improvement Activities (QIA) to support accreditation.

  • Oversees QIA program development.

  • Leads Quality projects in collaboration with clients.

  • Tracks performance of Core Performance Indicators (CPIs).

  • Collaborates with health plan clients on HEDIS measures measurement and improvement opportunities.

  • Collaborates with Corporate Quality on HEDIS rate production and client deliverables.

  • Monitors Service Level Agreements (SLA) relating to quality, and implements and monitors

  • Corrective Action Plans (CAPs) in collaboration with internal stakeholders, clients, and providers.

  • Implements and monitors CAPs related to Corporate Quality as well as external client delegation and regulatory audits for accreditation readiness.

  • Coordinates with Compliance on program integrity issues.

  • Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Qualifications

Requirements

  • Requires a BA/BS in a clinical or health related field; 10 years of experience in a healthcare environment, including prior management experience; or any combination of education and experience, which will provide an equivalent background.

  • 5 or more years of experience in Managed Care

  • 3 or more years working with NCQA/HEDIS programs

  • 3 or more years of experience directly managing teams

    Preferred Qualifications

  • MS or advanced degree in a health care related field

  • Current, active, unrestricted license is preferred

  • Experience working with behavioral health programs

  • Strong presentation skills and able to influence decisions are all levels

    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. Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.

    REQNUMBER: PS62507-2022

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