Anthem, Inc. BH Clin Qual Audit Analyst Sr (Performance Improvement Analyst) in Colorado Springs, Colorado
SHIFT: Day Job
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: The qualified candidate must reside in Colorado (preferably Front Range region).
Work Hours: Mon – Fri 8:00 am – 5:00 pm MST
Primary duties may include, but are not limited to:
Participates in on-site quality external audits such as Care Coordination, EQRO, accreditation, and regulatory and prepares audits of required documents; audits will be virtual during COVID-19 pandemic and on-site audits will be revisited when public health crisis status changes.
Provides recommendations for primary care practice transformation and quality improvement activities including selection of valid and reliable integrated care process and outcome indicators and coordinates monitoring and evaluation activities with colleagues and providers.
Demonstrates knowledge and application of quality improvement and process improvement technologies and methodologies such as LEAN, CQI and PDCA in the promotion of population health and integrated health care (i.e., physical, behavioral health and wellness).
Reviews quality and performance data and prepares concise, accurate and meaningful quality management reports in accordance with Company procedures.
Identifies opportunities for improvement through review of trend analyses and performance measurement reports and presentations and communicates information to colleagues and clients appropriately.
Assists in implementation and monitoring of quality improvement projects including, but not limited to the development of practice transformation and integrated health care practices such care management programming, and health outcomes improvement activities such as member education and outreach interventions, provider education and outreach interventions, client chart reviews, and performance improvement projects (PIPs).
Performs quality assurance activities on monthly, quarterly, annual and ad hoc bases, including chart reviews in relation to medical necessity and contract compliance.
Conducts quality of care investigations and using criteria closes case appropriately or refers to Quality Management Director or Chief Medical Officer for further review.
Prepares cases for Quality of Care Committee (QOCC) case presentations in relation to integrated health care service delivery and care coordination issues.
Current unrestricted RN (preferred), LCSW, LMFT, LPC or Clinical Psychologist license in applicable state(s) required.
2 years of experience in health care quality improvement and/or integrated care, 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.
RN, LCSW, LMFT, LPC or Clinical Psychologist; BA/BS degree in nursing, social work, counseling or behavioral health field with background and skills in quality management and experience in practice transformation and/or integration care settings.
Experience in conducting audits within a managed care health plan setting.
Local, in-state travel is 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. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.