The ideal candidate is someone with a strong QM background in the health insurance industry, including knowledge of HEDIS, NCQA and quality improvement initiatives.
Quality Improvement Administrator - Responsible for developing and implementing quality programs to assess health care professionals and monitor compliance and accreditation standards. Primary duties may include, but are not limited to:
Develops, implements, and analyzes existing processes relating to on-site review of physician offices.
Develops standard assessment and documentation tools to ensure compliance with accreditation standards.
Manages activities involving participating healthcare professionals to ensure that Anthem's members receive quality care through formal physician presentations, partnering with network management, marketing, and other areas.
Assists with the regional HP/DSM's in the development of guidelines and programs and interventions and collecting data for clinical quality improvement projects.
Requires an AS in nursing; 3 years of clinical experience as well as managed care or clinical quality improvement experience; or any combination of education and experience, which would provide an equivalent background.
Current unrestricted RN license in the State of District of Columbia preferred. BSN preferred.
Knowledge of health care delivery systems, and continuous quality improvement principles required.
Knowledge of NCQA, state and federal guidelines preferred.
Project management experience a plus.
Computer skills: MS Word, Outlook, Excel
Additional Salary Information: MRP of salary range is 79,200. Annual Incentive Plan 7.5% of base salary
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2017 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.