Clinical Quality Auditor Sr.

Elevance Health • Nashville, TN

5d • Remote

About The Position

The Clinical Quality Auditor Sr. is responsible for ensuring clinical quality through an audit process. Location: Virtual - This role enables associates to work virtually full-time, with the exception of required in-person training sessions (when indicated), 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 accommodation is granted as required by law. At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading. Join our Talent Community and stay connected with company news, information, and future job opportunities. Fueled by our bold purpose to improve the health of humanity, we are transforming from a traditional health benefits organization into a lifetime trusted health partner. Our nearly 100,000 associates serve approximately 100M+ people, at every stage of health. We address a full range of needs with an integrated whole health approach, powered by industry-leading capabilities and a digital platform for health.

Requirements

• Requires BS in nursing, health sciences, health management or a related clinical field and minimum of 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 applicable state(s) required.

Nice To Haves

• Advanced Practice Provider licensure and or clinical knowledge of APP practice.
• Experience with HEDIS gap closure.
• Experience with Medicare Risk Adjustment.
• Experience with ICD-10 Codes.
• Experience with EPIC Electronic Medical Record.
• Quality auditing and training.

Responsibilities

• Conducts virtual audits of APP/PA assessment encounters for existing advanced practice providers.
• Ensures encounters meet quality standards.
• 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.

Benefits

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level