Clinical Auditor Consult Sr - PS4942

Clinical Auditor Consult Sr - PS4942
Location: United States
Field: Medical
Requisition #: PS4942
Post Date: Apr 19, 2018
_Your Talent. Our Vision._ At Anthem, Inc., it?s
a powerful combination, and the foundation upon which we?re creating greater
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 healthcare .
This is an exceptional opportunity
to do innovative work that means more to you and those we serve at one of
America's leading health benefits companies and a Fortune Top 50 Company.
The Clinical Adherence Consultant Sr. is responsible for participating in Utilization Management (UM) activities that ensure programs meet accreditation and regulatory standards. Primary duties may include, but are not limited to:
+ Prepares UM Department for oversight audits.
+ Prepares corrective action plans in response to oversight body's request.
+ Conducts audits of UM processes and files.
+ Writes policies and procedures.
+ Assists with development of provider manuals audit tools and guidelines.
+ Coordinates flow of information and documentation between associates responsible for day-to-day activities related to accreditation or regulatory reviews.
+ Develops and implements accreditation and regulatory review tracking system.
+ Maintains accreditation and/or regulatory review adherence library.
+ Creates audit tools, reports standardized policies and procedures and provider manuals.
+ Facilitates implementation of survey or regulatory recommendations.
+ Assesses and evaluates progress towards meeting standards.
+ Recommends new process.
+ Trains associates on new and revised standards.
+ Compiles documentation for presentation to accrediting/regulatory organization.
+ Requires an AS in Nursing; 5 years of experience in a healthcare setting including 3 years of quality management experience and/or experiencing preparing for regulatory/accreditation audits; or any combination of education and experience which would provide an equivalent background.
+ Current unrestricted RN license in applicable state(s) required.
+ Knowledge of regulatory/accreditation standards required.
+ BSN is preferred.
+ Central Region Commercial experience preferred.
+ ACMP experience preferred.
+ Strong proficiency with MS Word, Excel and PowerPoint preferred.
+ Ability to travel may be required.
_Anthem,Inc. is ranked as one of America?s Most Admired Companies among health insurersby Fortune magazine and is a 2017 DiversityInc magazine Top 50 Company forDiversity. To learn more about our company and apply, please visit us atantheminc.com/careers. EOE. M/F/Disability/Veteran._

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