Clinical Quality Program Director

Description
SHIFT: Day Job
SCHEDULE: Full-time
Be a Part of an Extraordinary Team!
We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
At Beacon Health Options, a proud member of the Anthem, Inc. family of companies. For more than 30 years, Beacon Health Options has changed the way people live with behavioral health conditions. Beacon Health Options serves 37 million people across all 50 states. At Beacon, our mission is to help people live their lives to the fullest potential. Beacon offers superior clinical mental health and substance use disorder management, a comprehensive employee assistance program, work/life support, specialty programs for autism and depression, and insightful analytics to improve the delivery of care.
Clinical Quality Program Director
Location: All locations to be considered. Within 50 miles of an Anthem office.
The Clinical Quality Program Director is responsible for developing a national quality improvement strategy for our clinical program, which includes case management and utilization management for all lines of business. This role supports Case Management (CM) Program development and training - including NCQA required trainings, response to CM internal/external audits including CAP development, CM Organization Wide Steering Committee which facilitates the CM priority initiatives and decision making between CM and Quality leadership.
How you will make an impact:
+ Leads enterprise-wide quality strategy meetings.
+ Develops and facilitates the integration of a national quality plan. Identifies and integrates best practices into state programs.
+ Develops performance improvement plans and oversees the clinical quality improvement activities/projects.
+ Participates in the development, management, review and reporting of program outcomes for clinical quality programs.
+ Contributes to RFP and new product development.
+ Assures compliance with corporate Quality Improvement work plans.
+ Ensures research program documentation meets regulatory and Accreditation Standards.
+ Assures accurate and complete quantitative analysis of clinical data.
+ Leads department projects and mentors staff.
+ Prepares and presents program documents to senior management.
+ Creates reporting to support accreditation activities.
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.
Preferred Skills, Capabilities and Experiences:
+ Behavioral health experience strongly preferred
+ Case Management experience strongly preferred
+ Current unrestricted license or certification in an applicable field RN, LMHC, LCSW, LMFT
+ Work independently on annual behavioral health clinical trilogy documents (evaluation, work plan, and program description) which includes writing, data analysis and program development
+ Prior experience in behavioral health utilization management and case management program development
+ Ability to form strong working relationship with key Clinical leaders
+ Knowledge and experience with NCQA standards, policy updates, training materials, audit tools, file universes, and conducting trainings to support NCQA requirements
+ Participation in several cross-functional workgroups including clinical program and product development
+ Strong analytic skill set to promote collaboration and training between analytics and clinical leadership
+ Experience with data interpretation, collaboration with analytics team, and translation of data into actionable initiatives
+ Strong Presentation experience, presenting to Executive Leadership and internal business partners
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 Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. 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 age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact [email protected] for assistance.
REQNUMBER: PS71999-New%20York