Clinical Qual/Compli Admin (US)
Location: This position is eligible to work remotely in the the states listed; IN, CA, CT, GA, KY, LA, ME, NH, NY, OH, TX, VA
How you will make an Impact:
The Clinical Quality/Compliance Admin for FHPS will be responsible for coordinating Quality Management (QM) activities related to compliance and accreditation for an assigned SBU.
Primary duties may include but are not limited to:
Develops and maintains pertinent compliance plans.
Monitors adherence to plans and prepares status reports.
Conducts audits, identifies training and communication needs, and implements related programs.
Ensures all policies and procedures are updated as legislation or accreditation standards change.
Implements standardization of procedures and documentation within SBU.
Develops and delivers executive level presentations and represents senior management on compliance issues and related committees.
Requires a BA/BS and a minimum of 3 years compliance, audit or quality improvement experience; or any combination of education and experience which would provide an equivalent background.
Ability to travel overnight may be required.
Preferred Skills, Capabilities, and Experiences:
Experience with regulatory/accreditation audits and knowledge of regulatory/accreditation standards in a health or managed care environment is preferred.
RN a plus but not required.
Utilization management, Case Management or Disease Management experience is preferred.
Knowledge of NCQA a plus.
Experience within FHPS a plus
Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Be part of an Extraordinary Team
Elevance Health is a health company dedicated to improving lives and communities and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.
We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
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.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide and Elevance Health approves a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 Worlds Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.ElevanceHealth.com. 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 [ Email address blocked ] - Click here to apply to Clinical Qual/Compli Admin (US) for assistance.
EEO is the Law
Equal Opportunity Employer / Disability / Veteran
Please use the links below to review statements of protection from discrimination under Federal law for job applicants and employees.
Elevance Health, Inc. is an E-verify Employer
Email us ([ Email address blocked ] - Click here to apply to Clinical Qual/Compli Admin (US)) or call
- Case Management
- Clinical Works
- Disease Management
- Managed Care