• Quality Evaluator

    Elevance HealthIndianapolis, IN 46202

    Job #2689498616

  • Quality Evaluator

    Location: This position will work a hybrid model (remote and office). The Ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations.

    Preferred Location: Mason, OH.

    The Quality Evaluator is responsible for monitoring and evaluate clinical and non-clinical contact between program staff and participants, assessing adherence to protocols and appropriate clinical interaction. Evaluates calls 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.

    • Provides quality review process training.

    Minimum Requirements:

    • 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 Skills, Capabilities, and Experiences:

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