Quality Evaluator Advisor

at Elevance Health in Springfield, Illinois, United States

Job Description

Quality Evaluator Advisor

+ Job Family: Medical and Clinical

+ Type: Full time

+ Date Posted:May 22, 2023

+ Req #: JR68983



+ National +50 Miles away from nearest PulsePoint, National +50 Miles away from nearest PulsePoint


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.

How you will make an impact:

Responsible for evaluating clinical and quality performance by monitoring calls and correspondence. Ensures the delivery of excellent service to internal and external customers. Ensures that management is apprised of critical service quality issues, that staff receives appropriate training and performance feedback, and management receives appropriate recommendations regarding staff development.

Primary duties may include, but are not limited to:

+ Monitors, evaluates and documents member or provider calls for designated staff to ensure staff responses meet clinical and quality audit standards, and provides managers with call coaching quality data.

+ Partners with the management team to ensure frequent performance and developmental feedback is provided to staff.

+ Compiles and reports monitoring evaluation data and presents call coaching sessions.

+ Provides staff with an action plan for process improvement, and if needed collaborates with management in the corrective action process by gathering documentation regarding non-compliance in meeting required standards.

+ Contributes to performance improvement plans and participates in staff discussions.

+ Ensures processes are in place to support compliance with all state and federal laws (HIPAA), regulatory requirements, accrediting agencies (NCQA and URAC) as well as clinical criteria and policies and procedures.

+ Compiles and presents summary level call coaching and efficiency data.

+ Assures integrity and confidentiality of call monitoring documentation and evaluates and develops monitoring tools to support efficiency and effectiveness in the call monitoring process.

+ Audits the timeliness and accuracy of any contractual follow up inquiries. Measures the ability of staff to successfully meet all client performance expectations and presents final assessments to management.

+ Identifies improvements or training opportunities and develops and presents quality improvement training materials to improve overall service quality.

+ Identifies trends in inquiry monitoring and applies corrective actions as necessary to meet business needs.

+ Ensures follow through staff.

+ Develops ideas for performance improvement, service delivery, and cross-functional initiatives that contribute to department success.

+ Collaborates with management on new client implementation activities, including development and presentation of training materials, to ensure all service center and client performance expectations are met. ?

Minimum Requirements:

+ Requires BS/BA and a registered nurse or MS in Social Work or one of the core mental health disciplines and minimum of 5 years of post graduate clinical/administrative experience; or any combination of education and experience which would provide an equivalent background. Current, valid, unrestricted clinical license is required.

For candidates working in person or remotely in the below locations, the salary* range for this specific position is $61,920 to $111,456

Locations: California; Colorado; Nevada; Washington State; Jersey City, NJ; New York City, NY; Ithaca, NY and Westchester County, NY

In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws .

  • The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company’s sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Be part of an Extraordinary Team

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. A Fortune 20 company with a longstanding history in the healthcare industry, we are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

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.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health has been named as a Fortune Great Place To Work in 2022, has been ranked for five years running as one of the 2023 World’s Most Admired Companies by Fortune magazine, and is a growing Top 20 Fortune 500 Company. To learn more about our company and apply, please visit us at Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may cont

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Job Posting: JC240772617

Posted On: May 24, 2023

Updated On: Jun 07, 2023

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