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Clinical (RN Req's) Quality Au...

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Job Summary

Company
Anthem
Location
Nashville, TN
Industries
Other/Not Classified
Job Type
Full Time
Employee
Career Level
Experienced (Non-Manager)
Job Reference Code
4298_PS4478

Clinical (RN Req's) Quality Auditor Sr.(Substance Abuse) Middle TN - Statewide Travel (PS4478)

About the Job

Description

Your Talent. Our Vision. At Amerigroup, a proud member of the Anthem, Inc. family of companies focused on serving Medicaid, Medicare and uninsured individuals, 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.

This is an exceptional opportunity to do innovative work that means more to you and those we serve.

Location: This is a work@home opportunity with regular day, and overnight, travel through the state of Tennessee visiting provider offices. The ideal candidate will reside in Middle Tennessee.

This Clinical Quality Analyst Sr. role for Tennessee Medicaid focuses on Behavioral Health audits related to substance abuse and is responsible for ensuring clinical quality through an audit process that is focused on medical record documentation assessments. Primary duties may include, but are not limited to:

  • Conducts on-site audits of prospective and existing physicians and independent practice groups in the Tennessee Medicaid Division throughout the State of Tennessee.

  • Ensures that both utilization and quality programs related to substance abuse meet criteria.

  • Collects and analyzes data to formulate recommendations and solutions based on audit trends and results.

  • Compiles and maintains statistical data.
  • Prepares reports for management that define and evaluate problems and propose solutions.

Qualifications

Requires:

  • BS in nursing, health sciences, health management or a related clinical field; 5 years of experience in utilization management, quality assurance and/or plan administration or any combination of education and experience, which would provide an equivalent background.

  • Current unrestricted RN license in the State of Tennessee required.

  • Behavioral Health with experience in substance abuse.

  • Certified Professional in Healthcare Quality or Certified Professional Coder (CPC) a plus.

  • Must be willing to travel throughout the State of Tennessee approximately 75% of the time to visit provider offices and facilities.

  • There will be regular day and overnight travel required.

  • Proficient using MS Excel

Additional Qualifications:

  • Audit and analysis experience in healthcare industry 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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