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Clin Quality Audit Analyst Sr ...


Job Summary

Waukesha, WI
Other/Not Classified
Job Type
Full Time
Career Level
Experienced (Non-Manager)
Job Reference Code

Clin Quality Audit Analyst Sr - (Pewaukee) Waukesha, WI - 137437

About the Job

Your Talent. Our Vision. At Anthem, Inc., it's a powerful combination, and 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.
This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company.
Clinical Quality Audit Analyst Sr. - (Pewaukee) Waukesha, WI
Participates in on site quality external audits such as NCQA, AAHC and EQRO, and prepares audits of required documents. 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. Assist in implementation and monitoring of quality studies including, but not limited to the development and implementation of preventive health and chronic disease outcomes improvement interventions such as newsletter article, member education and outreach interventions, provider education and outreach interventions, medical record review, focus studies and surveys. Perform monthly, quarterly, annual and ad hoc medical record reviews such as HEDIS.

Requires 2 years of experience in quality improvement and HEDIS experience in a managed care setting. Knowledge of local and national quality management and regulatory standards, including NCQA and HEDIS reporting. Current unrestricted RN license in applicable state(s) preferred, with CPHQ preferred. BA/BS degree required; healthcare related degree preferred.
Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran.

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