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Anthem, Inc. RVP Medicare Stars, QM/RA Perf in Placentia, California


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 care companies and a Fortune Top 50 Company.

Title: Regional Vice President, STARS

Location(s): CA and TX

Position Summary

The RVP is responsible for developing, coordinating, communicating, and implementing a strategic clinical quality management and improvement program within a multi-state Medicare region. This position is a direct report to the Medicare regional President and is responsible for quality for all Medicare products in a large multi-state region. The RVP will lead directly and through corporate teams all revenue-enhancement efforts (RAF score improvement) as well as additional initiatives to support Stars improvement and coding accuracy and act as a subject matter expert to the other Medicare regions. In addition, the position is responsible for attaining high quality scores which can result in significant savings/revenue enhancement for the states within the region.

Position Responsibilities

  • Promotes understanding, communication, and collaboration with enterprise-wide leaders to ensure appropriate communication, integration and utilization of best practices

  • Oversees internal and state Quality Management (QM) Scorecard reporting

  • Provides oversight for the member complaint, appeal process, privacy compliance process, or auditing of delegated services in assigned area

  • Oversees Health Employer Data Information Sets (HEDIS) and/or CAHPS, including Value Based Purchasing (VBP) programs

  • Develops strategic HEDIS, CAHPS, VBP goals and objectives, ensures timely completion and develops contingency plans as needed

  • Supports the External Quality Review Organization (EQRO) reporting and state audit processes

  • Provides leadership for QM representation in new business activities

  • Ensures compliance with National Committee for Quality Assurance (NCQA) standards or other accrediting bodies (as applicable)

  • Leads regional and corporate QM committees and leadership meetings

  • Hires, trains, coaches, counsels, and evaluates performance of direct reports


Position Requirements

  • MS/MA in nursing, public health, healthcare administration, or other health care related field, required

  • 12+ years of experience in health care environment

  • 10 years of experience in a managed care organization QM role

  • 8 years of experience working with government sponsored health care programs; or any combination of education and experience, which would provide an equivalent background

  • Certified Professional Healthcare Quality (CPHQ) preferred

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at An Equal Opportunity Employer/Disability/Veteran.

REQNUMBER: PS42814-California