Anthem Clinical Quality/Compliance Admin-FEP-PS8141 in Bristol, Tennessee

Clinical Quality/Compliance Admin-FEP-PS8141

Location: United States

Field: Medical

Requisition #: PS8141

Post Date: Jun 13, 2018

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.

The Clinical Quality/Compliance Admin will be responsible for coordinating Quality Management (QM) activities related to compliance and accreditation for an assigned SBU. Primary duties may include, but are not limited to:

  • Develops and maintains pertinent compliance plans.

  • Monitors adherence to plans and prepares status reports.

  • Conducts audits, identifies training and communication needs, and implements related programs.

  • Ensures all policies and procedures are updated as legislation or accreditation standards change.

  • Implements standardization of procedures and documentation within SBU.

  • Develops and delivers executive level presentations and represents senior management on compliance issues and related committees.

This position may work from any Anthem location and can work remotely.

  • Requires a BA/BS; 3 years of compliance, audit or quality improvement experience; or any combination of education and experience, which would provide an equivalent background.

  • Experience with regulatory/accreditation audits and knowledge of regulatory/accreditation standards in a health or managed care environment is preferred.

  • Ability to travel overnight may be required.

  • Current unrestricted RN license in applicable state(s) is required.

  • Case management experience is required.

  • Utilization management experience is preferred.

  • Must have knowledge of NCQA.

  • Experience with WMDS, ECC, ACMP, and Tri-Med is strongly preferred.

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 antheminc.com/careers. EOE. M/F/Disability/Veteran.