/ 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.
Clinical Quality Program Admin - Columbia, SC - 122747
This position is responsible for overseeing the quality improvement 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.
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 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 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.
Requires a BS in health administration, nursing, or related clinical field.
MS in the health field (i.e. Nursing) preferred.
3 years of health care quality or data analysis experience; or any combination of education and experience, which would provide an equivalent background.
Strongly prefer RN or LPN.
Strongly prefer HEDIS and NCQA experience.
Strongly prefer managed care experience.
Current unrestricted license or certification in applicable field preferred (i.e. CPHQ).
/ Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2015 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. /
Title: RN or LPN Clinical Quality Program Administrator - Columbia, SC - 122747
Location: South Carolina-Columbia
Requisition ID: 122747
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