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Anthem, Inc. Behavioral Health HEDIS Quality Analyst in Fresno, California

Description

SHIFT: Day Job

SCHEDULE: Full-time

Beacon Health Options: Your Talent. Our Vision. At Beacon Health Options, 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.

For more than 30 years, Beacon Health Options has changed the way people live with behavioral health conditions. Today, we are the undisputed leader in behavioral health management, serving 37 million people across all 50 states. At Beacon, our mission is to help people live their lives to the fullest potential. Beacon offers superior clinical mental health and substance use disorder management, a comprehensive employee assistance program, work/life support, specialty programs for autism and depression, and insightful analytics to improve the delivery of care.

Location: REMOTE Oregon highly preferred Requires PST schedule

  • Behavioral health HEDIS measure management experience required (FUH)

  • Serves as the primary lead in the development, operationalization and evaluation of the health plan’s Quality Management trilogy documents including the application of Continuous Quality Improvement principles to conduct periodic assessments of program effectiveness.

  • Develop and implement annual provider oversight and audit plan to ensure compliance with health plan specific delegation requirements in accordance with local, state, federal and NCQA requirements.

  • Represent Quality Department at Health Plan’s or other state/client specific meetings where current quality activities including outcomes are discussed or presented.

  • Contribute to NCQA accreditation activities and conduct research, reporting, and data analysis focusing on NCQA accreditation activities to ensure ongoing compliance with the accreditation standards.

  • Primary duties may include, but are not limited to:

  • Provides recommendations for quality improvement studies including selection of valid and reliable indicators and coordinates monitoring and evaluation activities upon select implementation.

  • Analyzes data and prepares concise, accurate and meaningful quality management reports in accordance with Company procedures.

  • Defines opportunities for improvement through trend analysis and communicates information appropriately.

  • Assists in implementation and monitoring of quality studies including, but not limited to the development and implementation of behavioral health outcomes improvement interventions such as newsletter article, member education and outreach interventions, provider education and outreach interventions, medical record review, quality improvement activities (QIAs), focus studies and surveys.

  • Performs monthly, quarterly, annual and ad hoc medical record reviews such as HEDIS and CPG compliance.

  • Conducts quality of care investigations and using criteria closes case appropriately or refers to BH Medical Director for further review.

  • Prepares cases for Peer Review Committee

Qualifications

  • Requires RN, LCSW, LMFT, LPC or Clinical Psychologist;

  • 2 years of experience in quality improvement and 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.

  • Behavioral health NCQA, HEDIS exprience and Quality Improvement Measurement background required

  • Current unrestricted RN, LMHC, LCSW, LMFT, LPC or Clinical Psychologist license in applicable state(s) required.

  • BA/BS degree in nursing, social work, counseling or behavioral health field.

  • Travel may be required.

    Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 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.

    REQNUMBER: PS42680-California

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