Cerritos, California

Description

SHIFT: Day Job

SCHEDULE: Full-time

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.


Position: Behavioral Health Clinical Quality Audit Analyst Senior
Location: Remote / work from home in California
Shift: Monday - Friday 8:30am - 5pm

The BH Clinical Quality Audit Analyst Senior is responsible for participating in on-site quality external audits such as NCQA, AAHC and EQRO, and prepares audits of required documents. 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, 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.
  • Assists with the facilitation of the Quality of Care Committee meetings by preparing cases, organizing meeting materials, preparing agendas, and completing minutes.
  • Processes grievances and potential quality of care concerns including but not limited to conducting investigations, presenting information at Quality of Care Committee, and tracking and trending to identify opportunities for improvement.
  • Assists with requests for medical records by member, health plan and/or regulatory agency.
  • Works closely with internal departments at a regional level to ensure comprehensive, efficient and integrated systems that ensure communication and positive outcomes.

Qualifications

  • Education & Experience: Masters degree in behavioral health or human services field required; 3 years of experience in quality improvement, risk management, or utilization review in a managed care setting required; or any combination of education and experience, which would provide an equivalent background
  • Licensure: Current active unrestricted license in the state of CA such as RN, LCSW, LMHC, LPCC, or LMFT to practice as a health professional required

 

 

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.

 

Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s 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.

Cerritos, California

If you’re a reserve or veteran member of the military, we foster a welcoming environment that’s dedicated to honoring your service and helping you achieve your career goals. Veterans of Anthem — one of our Business Resource Groups — partners with our Talent Acquisition teams to maximize career offerings for you and your family members, striving to help you transition to civilian service and grow your career at the same time. 

Join Anthem's Military and Veteran Talent Network: https://anthemcareers.ttcportals.com/pages/military 

WE ARE HIRING

Anthem, Inc. is currently seeking military veterans and military spouses with operations experience.  Whether your experience is hands-on as an operational specialist or in operational leadership, Anthem wants to have an impact on your career and professional growth by speaking with you about their career opportunities.

If you are interested in learning more, check out Anthem's current open positions to the right for more information and to apply today!

Not sure where to start?  Send RecruitMilitary Success Manager, Taylor Groves, your questions at taylor.groves@recruitmilitary.com 

 

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