Job Details

ID #2751601
State California
City Westcovina
Full-time
Salary USD TBD TBD
Source Anthem
Showed 2019-10-03
Date 2019-10-04
Deadline 2019-12-02
Category Et cetera
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RN Quality Evaluator - Any Anthem Location or Remote - PS27900

California, Westcovina 00000 Westcovina USA

Vacancy expired!

RN Quality Evaluator - Any Anthem Location or Remote - PS27900Location: United StatesNewRequisition #: PS27900Your 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.Location: Any Anthem Location or Remote in the USThe Quality Evaluator is responsible to monitor and evaluate clinical and non-clinical contact between program staff and participants, assessing adherence to protocols and appropriate clinical interaction. Evaluates calls for these major areas: safety, clinical effectiveness, productivity and customer service.Primary duties may include, but are not limited to:

Provides written and/or verbal feedback to program staff to assist with performance improvement and staff development.

Develops reporting and overall performance trend identification.

Serves as the subject matter expert in the areas of clinical and non-clinical policies and procedures, use of the HMC software and call processes.

Ensures each associate meets standard performance criteria and ensures associates are moving program participants toward desired levels of engagement or enrollment, program retention and positive clinical outcomes (i.e. improved health).

Analyzes individual and overall trends based on monitoring results and providing recommendations to operations management or learning and Development.

Provides quality review process training.

Requires a BS/BA in nursing, social work, respiratory therapy or related clinical field; 3 years of experience in managed care to include experience in clinical staff development and education, quality; or any combination of education and experience, which would provide an equivalent background.

Current unrestricted license in applicable state(s) for designated field (i.e. RN, Social Work, Respiratory Therapy) required.

Clinically relevant certification (i.e. Certified Diabetes Educator, Certified Case Manager) and a background in quality or performance improvement preferred.

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.

Vacancy expired!

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