Quality EvaluatorLocation: This position will work a hybrid model (remote and office). The Ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations.Preferred Location: Mason, OH.The Quality Evaluator is responsible for monitoring and evaluate clinical and non-clinical contact between program staff and participants, assessing adherence to protocols and appropriate clinical interaction. Evaluates calls for these major areas: safety, clinical effectiveness, productivity and customer service.How you will make an impact:
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 HMC software 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.
Minimum Requirements:
Requires BS/BA in nursing, social work, respiratory therapy or related clinical field and minimum of 3 years of experience in managed care which includes experience in clinical staff development and education, quality; or any combination of education and experience, which would provide an equivalent background.
Current unrestricted license in applicable state(s) for designated field (i.e. RN, Social Work, Respiratory Therapy) required.
Preferred Skills, Capabilities, and Experiences:
Clinically relevant certification (i.e. Certified Diabetes Educator, Certified Case Manager) and a background in quality or performance improvement preferred.
