Clinical Quality Program Administrator - (Cary, NC) - PS24403

Job Description

Your Talent. Our Vision. At Healthy Blue, a strategic alliance of Blue Cross NC and Amerigroup, an Anthem Inc. company , 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 healthcare . 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. Location : This position is 100% office-based at our new offices in Cary, North Carolina.

The Clinical Quality Program Admin is responsible for overseeing the quality improvement activities/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.
• P erforms 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.
• P rovides oversight to assure accurate and complete quantitative analysis of clinical data and presentation of results.
• M ay provide oversight to the Healthcare Effectiveness Data and Information Set (HEDIS) project team.

• Requires an active and unrestricted RN license, in the state of North Carolina, or a compact RN license from a reciprocal state.
• Minimum of 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background, is required.
• Bachelor’s degree in nursing, health administration or related clinical field preferred.
• Experience in healthcare quality measurements (e.g. HEDIS, NCQA, URAC, regulatory compliance, or data analysis experience) required.
• Investigating quality of care incidences.
• Medicaid and/or Managed Care experience preferred
• Certification in applicable field (i.e. CPHQ) preferred.
• Experience collaborating with practitioners for quality improvement preferred.
• Ability to evaluate accreditation standards or regulations.
• Proficiency in Microsoft Office (Word, Excel, Outlook, PowerPoint) is required.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.