Anthem, Inc. CareMore Clinical Quality Auditor in San Antonio, Texas
SHIFT: Day Job
Your Talent. Our Vision. At CareMore, 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.
CareMore is a proven care delivery model for the highest-risk. We are a team of committed clinicians and business leaders passionate about transforming American healthcare delivery. We build and lead integrated, multi-disciplinary clinical teams to care for the most complex patients. We strive for excellence and have achieved significant and measurable improvement in total cost of care, clinical outcomes, and experience. As an Anthem subsidiary, we benefit from the scale and resources one of America’s largest managed healthcare organizations.
The CareMore Clinical Quality Auditor is responsible for performing Quality Management (QM) functions of the Health Care Services Department and ensuring QM compliance with health plan and regulatory standards. Primary duties may include, but are not limited to:
Serves as a resource to the plan and providers for QM issues.
Prepares, reviews, and analyzes daily/weekly/monthly reports that are maintained for statistical or regulatory purposes.
Monitors referral process and identifies opportunities for improvement.
Assists with audits and surveys.
Monitors, maintains and enhances Chronic Care Improvement Programs (CCIPs) and Quality Improvement Projects (QIPs). Completes medical record reviews and other related functions.
H.S. diploma and minimum of 3 years of related experience; or any combination of education and experience, which would provide an equivalent background.
Current LPN, LVN, or RN license in applicable state(s) required.
BS or MBA in Nursing 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.