Anthem, Inc. Clinical Quality Auditor Lead in Hamilton, New Jersey
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 care companies and a Fortune Top 50 Company.
Clinical Quality Auditor Lead
Location: Remote in NJ preferred; CT, NY, PA, VA also considered. (Travel to NJ required as needed.)
Responsible for participating in clinical quality management activities that ensure programs meet accreditation and regulatory standards. Primary duties may include, but are not limited to:
Prepares team for oversight audits.
Prepares corrective action plans in response to oversight body's request.
Conducts audits of Quality Management (QM) processes and files.
Writes policies and procedures and assists with development of provider manuals, audit tools, and guidelines.
Responsible for specific QM processes/ functions (i.e. compliance, grievances/appeals or HEDIS/quality improvement projects).
Assists manager with day-to-day monitoring and prioritizing of workflows and activities.
Develops and improves departmental processes and operations.
Monitors goals, performance and processes.
Assists with issues of non-compliance.
Mentors and coaches staff.
Trains new associates and re-trains current associate.
Monitors and prioritizes workflows.
Serves as a resource and a subject matter expert.
Requires a BS in nursing, health sciences, health management or a related clinical field; 5 years of experience in utilization management, quality assurance and/or regulatory/accreditation standards/audits including 3 years of quality management experience; or any combination of education and experience, which would provide an equivalent background.
Current active unrestricted license as an RN or LPN in applicable state is required.
Project Management, and Contractual experience required.
Medicare-Medicaid Plan (MMP) experience required.
Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
BSN and CPHQ (Certified Professional in Healthcare Quality) and prior project management experience is preferred.
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. Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s 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.