Anthem, Inc. Quality Management Analyst in Clearwater, Florida
SHIFT: Day Job
Your Talent. Our Vision. At Beacon Health Options, a proud member of the Anthem, Inc. family of companies, it’s a powerful combination. It’s 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.
For more than 30 years, Beacon Health Options has changed the way people live with behavioral health conditions. Today, we are the undisputed leader in behavioral health management, serving 37 million people across all 50 states. At Beacon, our mission is to help people live their lives to the fullest potential. Beacon offers superior clinical mental health and substance use disorder management, a comprehensive employee assistance program, work/life support, specialty programs for autism and depression, and insightful analytics to improve the delivery of care.
Location: Remote to the United States with preference to Colorado
Work Hours: Mon – Fri 8:00 am – 5:00 pm MST
Primary duties may include, but are not limited to:
Participates in on-site quality external audits such as Care Coordination, EQRO, accreditation, and regulatory and prepares audits of required documents; audits will be virtual during COVID-19 pandemic and on-site audits will be revisited when public health crisis status changes.
Provides recommendations for primary care practice transformation and quality improvement activities including selection of valid and reliable integrated care process and outcome indicators and coordinates monitoring and evaluation activities with colleagues and providers
Reviews quality and performance data and prepares concise, accurate and meaningful quality management reports in accordance with Company procedures.
Identifies opportunities for improvement through review of trend analyses and performance measurement reports and presentations and communicates information to colleagues and clients appropriately.
Assists in implementation and monitoring of quality improvement projects including, but not limited to the development of practice transformation and integrated health care practices such care management programming, and health outcomes improvement activities such as member education and outreach interventions, provider education and outreach interventions, client chart reviews, and performance improvement projects (PIPs).
Performs quality assurance activities on monthly, quarterly, annual and ad hoc bases, including chart reviews in relation to medical necessity and contract compliance.
Conducts quality of care investigations and using criteria closes case appropriately or refers to Quality Management Director or Chief Medical Officer for further review.
Prepares cases for Quality of Care Committee (QOCC) case presentations in relation to integrated health care service delivery and care coordination issues.
Conduct contract-required quality reviews to ensure compliance with policies, state and federal standards and client performance standards and participate in other monitoring assignments as required (i.e., Crisis Program, Care Coordination).
Works with Director of Crisis System Program and staff of Clinical, Provider Relations and QM Departments to establish and maintain processes for regular treatment record reviews (mental health, substance use, hospital, residential, care coordination and others as assigned).
Conduct contractual audits (Crisis System, Care Coordination, 411, EQRO), treatment record audits; and compile and report results.
Identify trends and patterns of deficiencies within practices, evaluate results, identify and communicate areas for improvement
Identify specific areas of focus for treatment record audits and provider training/education annually; evaluate results, identify, and communicate areas for improvement within the system.
Conduct and track adverse incident and quality of care issue investigations as needed; attend associated meetings and training.
Lead assigned meetings; participate in State, client and provider/facility meetings and performance improvement initiatives (PIPs, behavioral health, KPI measures) as directed.
Knowledge of crisis system (preferably has worked in crisis services before)
Knowledge/experience developing and implementing:
Performance Outcome Plans
Quality Improvement Plans
Corrective Action Plans
Current unrestricted RN (preferred), LCSW, LMFT, LPC or Clinical Psychologist license in applicable state(s) required.
2 years of experience in health care quality improvement and/or integrated care, 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.
RN, LCSW, LMFT, LPC or Clinical Psychologist; BA/BS degree in nursing, social work, counseling or behavioral health field with background and skills in quality management and experience in practice transformation and/or integration care settings.
Experience in conducting audits within a managed care health plan setting.
If not located in Colorado - travel to Colorado will be required
Applicable to Colorado Applicants Only
Annual Salary Range*: $64,800 – 81,000
Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
* The hourly or salary range is the range Anthem in good faith believes is the range of possible compensation for this role at the time of this posting. The Company may ultimately pay more or less than the posted range. This range is only applicable for jobs to be performed in Colorado. This range may be modified in the future. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.
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. An Equal Opportunity Employer/Disability/Veteran.
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.