Director Clinical Quality

Responsible for working with the regional head of health care management to direct the clinical quality initiatives, including NCQA accreditation and compliance with regulatory agencies and other objectives.

Primary duties may include, but are not limited to:

1. Works with both internal and external customers to promote understanding of health services activities and objectives within the company and to prioritize departmental projects according to Anthem corporate, regional, and departmental goals.
2. Maintains expert knowledge of current industry standards, quality improvement activities, and strong medical management skills.
3. Assures the training and continuing education of staff regarding standards and guidelines, including NCQA and HEDIS.
4. Hires, trains, coaches, counsels, and evaluates the performance of direct reports.

Qualifications:

• Requires BA/BS in a clinical or health care field (i.e. nursing, epidemiology, health sciences)
• 5 years progressively responsible management experience in a health care environment
• Any combination of education and experience, which would provide an equivalent background.
• MS or advanced degree in a health care related field (i.e. nursing, health education) or business strongly preferred.
• Previous experience working with NCQA accreditation required.
• Previous experience working with HEDIS preferred.

Additional Information

All your information will be kept confidential according to EEO guidelines.