Shift: Wednesday - Saturday; 8:30am – 7:00pm CST  

Location: Hybrid 1, CST time zones preferred, alternate locations may be considered

Hybrid 1: This role requires associates to be in-office 1 day per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered. 

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

The Clinical Quality Auditor Lead is responsible for participating in clinical quality management activities that ensure programs meet accreditation and regulatory standards.

How you will make an impact:

• Prepares team for oversight audits.
• Prepares corrective action plans in response to oversight body's request.
• Conducts audits of Quality Management (QM) processes and files.
• Writes policies and procedures and assists with development of provider manuals, audit tools, and guidelines.
• Responsible for specific QM processes/ functions (i.e. compliance, grievances/appeals or HEDIS/quality improvement projects).
• Assists manager with day-to-day monitoring and prioritizing of workflows and activities.
• Develops and improves departmental processes and operations.
• Monitors goals, performance and processes.
• Assists with issues of non-compliance.
• Mentors and coaches staff.
• Trains new associates and re-trains current associate.
• Monitors and prioritizes workflows.
• Serves as a resource and a subject matter expert.

Minimum Requirements:

• Requires BS in nursing, health sciences, health management or a related clinical field and minimum of 5 years of experience in utilization management, quality assurance and/or regulatory/accreditation standards/audits which includes a minimum of 3 years of quality management experience; or any combination of education and experience, which would provide an equivalent background.
• Current active unrestricted license such as an RN, LCSW, LMSW, LMHC, LPC, LBA (as allowed by applicable state laws), LMFT, or clinical Psychologist, to practice as a health professional within the scope of licensure in applicable states or territory of the United States required.
• For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
• For associates working within Puerto Rico who are member or patient facing either in a clinical setting or in the Best Transportation unit, a current PR health certificate and a current PR Law 300 certificate are required for this position.

Preferred skills, capabilities, and experiences:

• BSN and CPHQ (Certified Professional in Healthcare Quality) and prior project management experience preferred.
• LPN’s and LVN’s may also be considered for this role

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

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.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health 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 elevancehealthjobssupport@elevancehealth.com for assistance.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.