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Director Clinical Quality Management

Company Name:
UniCare Life & Health Insurance Company
Job Description
Anthem Blue Cross and Blue Shield is a proud member of the WellPoint family of companies. At Anthem, we are working together to transform health care with trusted and caring solutions.
Bring your expertise to our innovative culture where you will have the opportunity to make a difference in people's lives, and to take your career further than you can imagine.
Director Clinical Quality Management will be responsible for driving the development, coordination, communication, and implementation of a strategic clinical quality management and improvement program within assigned health plan.
Primary duties may include, but are not limited to:
Directs and provides leadership for implementing, monitoring and evaluating the Quality Management Program for the health plan.
Promotes understanding, communication, and coordination of the quality management program.
Directs and provides leadership for compliance with National Committee for Quality Assurance (NCQA) standards.
Provides leadership for the interpretation of results and development of improvement action plans arising from provider and member satisfaction surveys.
Serves as a resource for the design and evaluation of process improvement plans/quality improvement plans and ensures they meet Continuous Quality Improvement (CQI) methodology and state contractual requirements.
Collaborates with other leaders in developing, monitoring, and evaluating Healthcare Effectiveness Data Information Set (HEDIS) improvement action plans, year round medical record review, and over read processes.
Monitors and reports quality measures per state, Centers for Medicare and Medicaid Services (CMS), and accrediting requirements.
Hires, trains, coaches, counsels, and evaluates performance of direct reports.
Job Qualifications
Requires a BA/BS in a health or business related field; 8 years of experience in a similar position in a healthcare environment, including prior management experience; or any combination of education and experience, which would provide an equivalent background. MSN, MPH, or MPA preferred. Current clinical license preferred. Clinical Quality Management experience in a Medicaid Managed Care Organization strongly preferred.
WellPoint is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine, and is a 2013 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company please visit us . EOE.M/F/Disability/Veteran.
Once an offer is accepted, all external applicants are subject to a background investigation and if appropriate, drug testing. Offers of employment shall be contingent upon passing both the background investigation and drug testing (if required).
Current WellPoint associates: All referrals must be submitted through the formal associate referral process on WorkNet. Official guidelines for the associate referral program can be found in My HR.

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