Anthem In. Case Management Jobs

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Anthem, Inc. Clinical Quality Program Director in Pico Rivera, California

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 benefits companies and a Fortune Top 50 Company.

Clinical Quality Program Director

Responsible for developing a national quality improvement strategy for a major line of business.

Primary duties may include but are not limited to:

  • Direct and provide oversight for Health Education & Health Equity work for local health plan

  • Manage daily DHCS and LA Care responsibilities and operations for Health Education

  • Implement APLs as required; maintain oversight for current implementation of APLs (e.g. Diabetes Prevention Program)

  • Responsible for DHCS and LA Care Audits

  • Oversee process of review and development of health education materials

  • Be Point of Contact for health educational referrals; Work with Case Management to ensure ongoing provision of health education services; Represent at Provider JOMs

  • Oversee Member Incentives

  • Coordinate work for with Community Relations

  • Monthly reporting of statewide activities

  • Identify Disparities in Population and work with other departments to develop interventions.

  • Potential Areas of focus: populations with special needs, Limited English proficiency, children, groups with disparities

  • Lead effort to develop Population Needs Assessment and manage action plan (DHCS requirement); Develop Disparities Report Card for counties.

  • Lead local NCQA Multicultural Health Care Distinction work around addressing disparities.

  • Engage Community Advisory Committees for Health Equity work plan.

  • Work with national level Corporate partners to implement programs to reduce health disparities.

  • Collaborate with Community partners to develop programs.

  • Work closely with Provider Performance Medical Director and QM Director to develop strategic goals and action plans.

  • Work with Special Programs Director to integrate SDOH programs into health equity work plan implementation.

  • Work with data team to identify disparities and create evaluation plans for measuring reduction of disparities.

  • Thought leader – LinkedIn curating articles, local presentations, sharing work; Identify opportunities to collaborate with academic institutions.

  • DHCS Disparity PIP project SME.

  • Cultural and Linguistics – Continue to oversee as a function under Health Equity.

Qualifications

Minimum Requirements

  • Requires a BS in health administration, nursing or a related clinical field; 5 years of health care quality or data analysis experience; or an equivalent combination of education and experience, which would provide an equivalent background.

  • Must live within reasonable distance to Anthem office in California for meetings, trainings, etc.

  • Requires Master in Public Health (MPH) in the State of California.

    Preferred Qualifications

  • Knowledge of state or assigned line of business needs and priority improvement areas strongly preferred.

  • Current unrestricted license or certification in an applicable field (i.e. CPHQ) or MS in the health field (i.e. Nursing) preferred.

  • Health Equity experience preferred.

  • Culture and linguistics experience preferred.

  • Master Certified Health Education Specialist (MCHES) Preferred

  • Quality experience 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. The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide - and Anthem approves - a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws. 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. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.

    REQNUMBER: PS63969

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