Clinical Quality Auditor Lead

Elevance Health•Atlanta, IN

3d•Remote

About The Position

Clinical Quality Auditor Lead Must Have An Active Clinical License. Location: Virtual - This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Work Shift Hours: Monday – Friday, 8 am to 4:30 pm Or 9 am to 5:30 pm The Clinical Quality Auditor Lead is responsible for participating in clinical quality management activities that ensure programs meet accreditation and regulatory standards. How you will make an impact: Prepares team for oversight audits. Prepares corrective action plans in response to oversight body's request. Conducts audits of Quality Management (QM) processes and files. Writes policies and procedures and assists with development of provider manuals, audit tools, and guidelines. Responsible for specific QM processes/ functions (i.e. compliance, grievances/appeals or HEDIS/quality improvement projects). Assists manager with day-to-day monitoring and prioritizing of workflows and activities. Develops and improves departmental processes and operations. Monitors goals, performance and processes. Assists with issues of non-compliance. Mentors and coaches staff. Trains new associates and re-trains current associate. Monitors and prioritizes workflows. Serves as a resource and a subject matter expert.

Requirements

Requires BS in health sciences, health management or a related clinical field and minimum of 5 years of experience in utilization management, quality assurance and/or regulatory/accreditation standards/audits which includes a minimum of 3 years of quality management experience ; or any combination of education and experience, which would provide an equivalent background.
Current, active, unrestricted license such as either a LCSW, LMSW, LMHC, LPC, LMFT, or clinical Psychologist , to practice as a health professional within the scope of licensure in applicable states or territory of the United States is required .

Nice To Haves

Master’s Degree is highly preferred.
Experience with Autism and ABA.
Experience in providing training to staff.
Strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Responsibilities

Prepares team for oversight audits.
Prepares corrective action plans in response to oversight body's request.
Conducts audits of Quality Management (QM) processes and files.
Writes policies and procedures and assists with development of provider manuals, audit tools, and guidelines.
Responsible for specific QM processes/ functions (i.e. compliance, grievances/appeals or HEDIS/quality improvement projects).
Assists manager with day-to-day monitoring and prioritizing of workflows and activities.
Develops and improves departmental processes and operations.
Monitors goals, performance and processes.
Assists with issues of non-compliance.
Mentors and coaches staff.
Trains new associates and re-trains current associate.
Monitors and prioritizes workflows.
Serves as a resource and a subject matter expert.

Benefits

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).
merit increases
paid holidays
Paid Time Off
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
financial education resources