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.
The BH Clinical Quality Audit Analyst is responsible for developing, coordinating, implementing, and evaluating quality improvement activities including data and outcome measurements for behavioral health population according to the Behavioral Health Quality Management (BHQM) program.
Primary duties may include, but are not limited to:
* Designs and implements quality improvement studies.
* Analyzes data and prepares quality management reports in accordance with BH QM principles.
* Participates in intra-departmental teams to improve sustainable member outcomes.
* Assists in defining opportunities for improvement identified through analysis of trends.
* Coordinates resolution of high level complaints. Assists in the preparation of RFPs.
* Assists with coordinating improvement activities that improve HEDIS and member satisfaction.
* May meet with physician offices for provider collaboration activities and education.
* 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.
* Requires BA/BS in nursing, social work, or psychology.
* 80% regional local travel may be required.
* HEDIS subject knowledge preferred.
* Strong ability to manipulate and analyze data required.
* Minimum intermediate level MS Excel experience 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.
Associated topics: addiction, behavioral health, cell, clinician, counselor, lmsw, mental health, rww, social worker, substance