Anthem, Inc. BH Clin Qual Audit Analyst Sr in Bradenton, Florida
SHIFT: Day Job
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.
Given Anthem’s scale, balance sheet, broad national reach and depth at the local market level, Anthem has established a new business unit called the Diversified Business Group. The Diversified Business Group is a solutions-oriented business unit within the Company that will support Anthem and other external clients in the pursuit of transforming healthcare.
BH Clin Qual Audit Analyst Sr.
Location: Remote position
Summary: Responsible for participating in on-site quality external audits such as NCQA, AAHC and EQRO, and prepares audits of required documents.
Primary duties may include, but are not limited to:
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.
Assists in implementation and monitoring of quality studies including, but not limited to the development and implementation of behavioral health outcomes improvement interventions such as newsletter article, member education and outreach interventions, provider education and outreach interventions, medical record review, focus studies and surveys.
Performs monthly, quarterly, annual and ad hoc medical record reviews such as HEDIS and CPG compliance.
Conducts quality of care investigations and using criteria closes case appropriately or refers to BH Medical Director for further review.
Prepares cases for Peer Review Committee
Requires RN, LCSW, LMFT, LPC or Clinical Psychologist; 2 years of experience in quality improvement and/or behavioral health, risk management and/or utilization review in a managed care setting; or any combination of education and experience, which would provide an equivalent background.
Current unrestricted RN, LCSW, LMFT, LPC or Clinical Psychologist license in applicable state(s) required. BA/BS degree in nursing, social work, counseling or behavioral health field. 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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