Quality Evaluator - Therapist Sr. (CareBridge)

Elevance Health • Nashville, TN

7d • Remote

About The Position

The Quality Evaluator – Therapist Sr. is responsible for monitoring and evaluating clinical and non-clinical contact between program staff (physical therapy/occupational therapy) and participants, assessing adherence to protocols and appropriate clinical interaction. Evaluates calls for these major areas: safety, clinical effectiveness, productivity and customer service. Audits more complex cases. Audits the work of therapists. 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.

Requirements

• Requires a graduate of a college level program in physical therapy occupational therapy or speech language pathology and minimum of 3 years of managed care experience; or any combination of education and experience which would provide an equivalent background.
• Current active unrestricted license or certification as a physical therapist occupational therapist or speech language pathologist in applicable state required.
• Certification and/or licensure appropriate to field of specialty as required.

Nice To Haves

• Experience in quality or performance improvement preferred.

Responsibilities

• Provides written and/or verbal feedback to program staff to assist with performance improvement and staff development.
• Develops reporting and overall performance trend identification.
• Serves as the subject matter expert in the areas of clinical and non-clinical policies and procedures, use of the applicable systems and call processes.
• Ensures each associate meets standard performance criteria and ensures associates are moving program participants toward desired levels of engagement or enrollment, program retention and positive clinical outcomes (i.e. improved health).
• Analyzes individual and overall trends based on monitoring results and providing recommendations to operations management or learning and Development.
• Provides quality review process training.
• Acts as a resource for internal staff.
• Participates in or leads intradepartmental teams’ projects and initiatives.

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
• Education Level: No Education Listed