Anthem Clinical Population Health/Strategy Director - PS10641 in Witchita, Kansas

Clinical Population Health/Strategy Director - PS10641

New

Location: Atlanta, Georgia, United States

Field: Medical

Requisition #: PS10641

Post Date: Jul 31, 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.

Location:

Atlanta, GA

May consider other locations

Job Summary:

Responsible for working with multiple matrix partners to drive provider profiling and care enablement strategies behind multiple national provider, employer and consumer transparency programs. Collaborates with the Provider Solutions, Medical Management, National Account, and Local Account Management teams for Enterprise Clinical Programs (case management/disease management/utilization management), Enterprise Clinical Quality Management Programs, Provider Transparency Programs, and Network Management Programs.

Primary duties may include, but are not limited to:

  1. Oversees, creates, identifies, and leads the Clinical Quality Management components of Provider Profiling components and Client Analytic strategies.

  2. Drives clinical strategy discussions from brainstorming to designing new workflow by consulting with functional business owners and program/strategy leadership.

  3. Reports results through various venues as well as to the leadership team.

  4. Oversees and leads work with business owners to create documents and tools to reflect interaction with providers and employers around care management of members or clinical quality management accountabilities of members, and provider quality performance.

  5. Collaborates and coordinates with chief medical officers and other business partners for changes needed in existing systems/processes.

  6. Participates in meetings and work groups.

  7. Responsibilities for Enterprise Clinical Programs may also include: Influences and helps shape program design based on in depth knowledge of the current clinical landscape and shared services strategy and how it relates to/coordinates with provider and employer programs by creating easily navigable coordination, workflow and processes whereby interacting with providers, employers and members is efficient and effective.

  8. Responsibilities for Enterprise Clinical Quality Management may also include: Monitors, drives and recommends appropriate solutions based on in depth knowledge of existing QM requirements inclusive of NCQA/URAC, HEDIS, VBP, Trilogy documents, reporting requirements and key metrics. Monitors and eliminates risk with respect to clinical adherence tied to patient safety and quality of care. Determines opportunities to leverage role and evolution of provider and employer strategies to enhance how provider performance is measured and how transparency/clinical programs can better connect members to more personalized care.

  • Requires BA/BS degree in related field.

  • 10-15 years of leadership/management experience in health care management, marketing clinical programs/products, and managing significant business results.

  • Any combination of education and experience, which would provide an equivalent background.

  • MBA preferred.

  • Previous P&L and/or project management experience in health care setting preferred.

  • Travel may be 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