Anthem Clin Quality Audit Analyst Sr in Long Beach, California
Clin Quality Audit Analyst Sr
Location: United States
Requisition #: PS24524
Post Date: Sep 05, 2019
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.
The Clinical Quality Audit Analyst Senior Participates in on site quality external audits such as NCQA, AAHC and EQRO, and prepares audits of required documents. Provides recommendations for quality improvement studies including selection of valid and reliable indicators and coordinates monitoring and evaluation activities upon select implementation. Analyzes data and prepares concise, accurate and meaningful quality management reports in accordance with Company procedures; defines opportunities for improvement through trend analysis and communicates information appropriately.
Other duties include but are not limited to:
Assist in implementation and monitoring of quality studies including, but not limited to the development and implementation of preventive health and chronic disease outcomes improvement interventions such as newsletter article, member education and outreach interventions, provider education and outreach interventions, medical record review, focus studies and surveys.
Perform monthly, quarterly, annual and ad hoc medical record reviews such as HEDIS and CPG compliance;
Conduct quality of care investigations and using criteria closes case appropriately or refer to Medical Director for further review; prepares cases for Peer Review Committee.
Qualified candidates will possess:
2 years experience in quality improvement, risk management and/or utilization review in a managed care setting.
Knowledge of local and national quality management and regulatory standards, including NCQA and HEDIS reporting.
Current unrestricted RN license in applicable state(s) required, with CPHQ preferred.
BA/BS degree in Nursing 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.
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