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Clinical Quality Auditor Sr

Location:

  • Nebraska, Nebraska
  • Nebraska, Omaha
  • NE, Lincoln

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Description

Job Description: External

Location: Temporary remote.  Hybrid schedule

Schedule: M-F 8am-5pm CT

Responsible for assessment of quality performance and ensuring clinical quality through an audit process. Primary duties may include, but are not limited to:

  • Conducts virtual and/or on-site audits of prospective and existing physicians and independent practice groups.
  • Collects and analyzes data to formulate recommendations and solutions based on audit trends and results, providing providers scorecards including benchmarks and goals for closing care gaps and addressing opportunities for improvement.
  • Compiles and maintains statistical data.
  • Convenes meetings with local market and national associates/leaders to discuss identified areas of opportunity and trends with subsequent development of a strategy to address.
  • In partnership with provider(s), evaluates quality opportunities for implementation by establishing a project plan that identifies goals and objectives for improvement and supports provider-specific incentive program(s).
  • Prepares reports for management that define and evaluate problems and propose solutions.
  •  Ensures that both utilization and quality programs meet criteria.

Job Qualifications: External

  • Requires BS in health administration, nursing, health sciences, health management or a related clinical field; 3 years of health care quality experience and/or plan administration; or any combination of education and experience, which would provide an equivalent background.
  • Managed care experience, clinical behavioral health experience, current unrestricted license, and certification in applicable field preferred.

Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Be part of an Extraordinary Team

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.

We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

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.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.ElevanceHealth.com. 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 ability@icareerhelp.com for assistance.

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