Healthcare Quality Evaluator at Elevance Health in Mason, Ohio

Job Description:

Location: Mason OH, Nashville TN, Atlanta GA, Tampa FL




Hours: Monday - Friday




Travel: Hybrid (1-2 days onsite) (Minimal travel to local Hospital as needed)




Position Overview:



Responsible to monitor and evaluate clinical and non-clinical contact between program staff and participants, assessing adherence to protocols and appropriate clinical interaction. Evaluates transitional care services for clinical effectiveness for these major areas: safety, clinical effectiveness, productivity and customer service.



How You Will Make an Impact:

• 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
  
  


• Analyzing and managing hospital chart reviews and inquiries
  
  


• Provides quality review process training
  
  

Required Qualifications:

• Requires BS/BA in nursing, social work, respiratory therapy or related clinical field and minimum of 3 years of experience in managed care which includes 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.
  
  

Preferred Qualifications:

• Active RN license is a must
  
  


• HEDIS transition of care experience is a must
  
  


• Medication reconciliation experience preferred
  
  

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

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.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance. Apply Now