Your Talent. Our Vision. At Empire Blue Cross Blue Shield, a proud member of the Anthem, Inc. family of companies, 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.
NOTE: This is not a "consultant" position. This is a high level, full-time, individual contributor, employee with benefits position.
The Process Improvement Consultant will be pro-active in identifying process improvement quality initiatives. You will work in the WNY Health Plan as well as from home. Your focus will be to develop programs and processes to support of our Medicaid members with physical with behavioral health issues, as well as our network providers on the implementation of these processes and programs. Included in this role is the tracking of results via HEDIS and QARR measures, quality audits and reporting to various quality committees.
Responsible for generating process improvements that bring about measurable improvement in quality and/or efficiency. Contributes to achieve department's objectives by serving as key contact for researching and implementing solutions and tools for new systems and other key operational improvements, provide guidance to leads, operations experts, associates, and/or managers on process improvement issues.
Primary duties may include, but are not limited to:
Represents the department on process improvement teams, special projects and implementation of new technology.
Lead role in coordinating annual review/revision of procedures.
Leads the training of associates when new processes or procedures are implemented.
Communicates process information and facilitates workgroups to ensure accurate and consistent workload reporting.
Review /analyze monthly workload reports to ensure goals are on-target (timeliness, backlog) across all operational sites.
Identify areas of concern & implement corrective plans if necessary.
Uses reports and production statistics to represent unit in departmental process improvement and system changes and provides specialized input on reports to management.
Requires a BA/BS degree in a related field, 5+ years of related experience; or any combination of education and experience, which would provide an equivalent background.
Prefer a NY license as an LCSW, LMHC, RN or similar.
Experience in quality management in the health insurance field required.
Experience with HEDIS/QARR preferred.
Experience in program management and the implementation of new programs preferred.
Demonstrate ability to analyze existing and potential workflows, processes, supporting systems, and procedures and identifying improvements required.
Excellent oral, written and interpersonal communication skills required.
Strong analytical, organizational, planning, problem solving and project/decision facilitation skills required.
Computer skills: MS Office (Word, Outlook, Excel)
Ability to work in the Buffalo, NY office on a regular basis.
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.
An Equal Opportunity Employer/Disability/Veteran