Anthem Inc. Virginia Jobs

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Anthem, Inc. Staff VP HEDIS & Quality Performance Improvement in Richmond, Virginia

Description

SHIFT: Day Job

SCHEDULE: Full-time

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 care companies and a Fortune Top 50 Company.

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.

Title: Staff VP HEDIS and Quality Performance Improvement (Staff VP HEDIS Medical Record Review)

Location: This position will be hybrid work from home and within an office setting.

The incumbent for the Staff VP HEDIS & Quality Performance Improvement will be responsible for strategic leadership and oversight of enterprise-wide Health Employer Data Information Set (HEDIS) Medical Record Review (MRR) management and reporting with a strong focus on Quality Performance Improvement.

Primary duties may include but are not limited to:

  • Develops and implements “annual HEDIS MRR and supplemental data from medical records” strategy and model to be applied across all lines of business, ensure proper enterprise-wide processes are in place for HEDIS data collection.

  • Collaborates with regional and local quality teams to ensure successful execution of annual HEDIS medical record review process

  • Researches applicable subject matter practices and remains aware of industry standards and trends related to HEDIS Specifications and reporting to ensure design and implementation of best practices.

  • Oversees processes to ensure compliance with all HEDIS CMS, NCQA, and state standards.

  • Leads MRR portion of HEDIS audits and manages enterprise-wide HEDIS MRR projects and readiness.

  • Provides leadership of MRR team to be quality consultants to provider systems and practices for quality and health equity improvement.

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

Qualifications

Preferred Qualifications:

  • Knowledge of and previous experience working with NCQA and HEDIS MRR is strongly preferred

  • Coding Certification (CPC, CCS, CCS-P, CMC, OR COC)

  • Bi-lingual (Spanish)

  • Active State Medical Licensure in at least one state within the U.S. CA or TX is highly preferred

  • MS or advanced degree in a health care related field such as nursing, health education, and current license (such as an RN) are 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. 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: PS55309-US

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