Anthem Quality Evaluator Lead-FEP 134475 in Richmondville, New York

/ 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 Quality Educator Lead- FEP will be responsible for leading a team of clinicians and non-clinicians who monitor and evaluate clinical and non-clinical contact between program staff and participants, assessing adherence to protocols and appropriate clinical interaction, and ensuring calls are evaluated for safety, clinical effectiveness, productivity and customer service. Primary duties may include, but are not limited to:

  • Assists manager with day-to-day monitoring and prioritizing of workflows and activities.

  • Develops and improves departmental processes, procedures and operations.

  • Monitors local Quality Evaluator time, performance and processes.

  • Conducts performance audits on Quality Evaluator activities.

  • Assists with issues of non-compliance on the local QE team.

  • Mentors and coaches staff to accomplish assigned projects and job functions.

  • Assists with the training of new associates and re-trains current associate(s) as needed.

  • Monitors Quality Evaluators and prioritizes shift workflows, including adjustments, and assigns mentoring requests.

  • Meets regularly with Care Center Quality Evaluation Team as well as the Learning team in order to stay informed to changes in protocols, policies and/or processes.

  • Serves as knowledge and resource expert for assigned functions and projects.

  • Elevates team member performance issues to manager.

    This position may work Remote from any of our Anthem locations.

  • Requires a current unrestricted license in applicable state(s) for designated field (i.e. RN, Social Work, Respiratory Therapy) or a BS/BA in related unlicensed clinical field (i.e. exercise psychology); 5 years of experience in managed care including at least 2 years of experience in clinical staff education/training, quality; or any combination of education and experience, which would provide an equivalent background.

  • Clinically relevant certification (i.e. Certified Diabetes Educator, Certified Case Manager) and a background in quality or performance improvement preferred.

  • NCQA and HEDIS experience is desired.

  • Must have auditing experience.

  • Previous leadership experience is a plus.

/ Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at EOE. M/F/Disability/Veteran. /

Job Medical

Equal Employment Opportunity Statement Anthem, Inc. will recruit, hire, train and promote persons in all job titles without regard to age, color, disability, gender (including gender identity), marital status, national origin, race, religion, sex, sexual orientation, veteran status, or other status protected by applicable law. In addition, all personnel actions such as compensation, promotion, demotion, benefits, transfers, staff reductions, terminations, reinstatement and rehire, company-sponsored training, education and tuition assistance, and social and recreational programs will be administered in accordance with the principles of equal employment opportunity.

Title: Quality Evaluator Lead-FEP 134475

Location: new york-Richmondville

Requisition ID: 134475