Job ID: JP00044424

Anticipated Start Date: 05/06/2024

Please note this is the target date and is subject to change. BCforward will send official notice ahead of a confirmed start date.

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.

We are looking for contract workers (via BCforward) who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

MUST BE LOCATED WITHIN 50 MILES OF A PULSEPOINT LOCATION: LOUISVILLE, KY, WOODLAND HILLS, CA, ATLANTA, GA, NORFOLK, VA, INDIANAPOLIS, IN, BOSTON, MA.

Primary duties may include, but are not limited to:

• Participates in on site quality external audits such as NCQA, AAHC, and EQRO, and prepares audits of required documents.
• Provides recommendations for quality improvement studies including selection of valid and reliable indicators and coordinates monitoring and evaluation activities upon select implementation.
• Analyzes data and prepares concise, accurate and meaningful quality management reports in accordance with Company procedures; defines opportunities for improvement through trend analysis and communicates information appropriately.
• Assist in implementation and monitoring of quality studies including, but not limited to the development and implementation of preventive health and chronic disease outcomes improvement interventions such as newsletter article, member education, and outreach interventions, provider education and outreach interventions, medical record review, focus studies and surveys.
• Perform monthly, quarterly, annual, and ad hoc medial record reviews such as HEDIS and CPG compliance.
• Conduct quality of care investigations and using criteria closes case appropriately or refer to Medical Director for further review; prepares cases for Peer Review Committee.

Requirements:

• Requires 2 years experience in quality improvement, risk management, and/or utilization review in a managed care setting.
• Knowledge of local and national quality management and regulatory standards, including NCQA and HEDIS reporting.
• Current unrestricted RN license in applicable state(s) required, with CPHQ preferred.
• BA/BS degree in Nursing preferred.
• Licensure as RN, MSW, LISW, LCSW, LMHC, LMFT or equivalent is required.
• Background in auditing, provider/medical record reviews, and clinical experience is helpful.

Job Type: Contract role.

Additional Details:

• Shifts: 8-5 pm EST M-F.
• 100% remote work opportunity.
• Must be located 50 miles from a PulsePoint location.
• Examples of PulsePoint Locations: LOUISVILLE, KY, WOODLAND HILLS, CA, ATLANTA, GA, NORFOLK, VA, INDIANAPOLIS, IN, BOSTON, MA.

About BCforward:

Founded in 1998 on the idea that industry leaders needed a professional service, and workforce management expert, to fuel the development and execution of core business and technology strategies, BCforward is a Black-owned firm providing unique solutions supporting value capture and digital product delivery needs for organizations around the world. Headquartered in Indianapolis, IN with an Offshore Development Center in Hyderabad, India, BCforward’s 6,000 consultants support more than 225 clients globally.

BCforward champions the power of human potential to help companies transform, accelerate, and scale. Guided by our core values of People-Centric, Optimism, Excellence, Diversity, and Accountability, our professionals have helped our clients achieve their strategic goals for more than 25 years. Our strong culture and clear values have enabled BCforward to become a market leader and best in class place to work.

BCforward is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against based on disability.

To learn more about how BCforward collects and uses personal information as part of the recruiting process, view our Privacy Notice and CCPA Addendum. As part of the recruitment process, we may ask for you to disclose and provide us with various categories of personal information, including identifiers, professional information, commercial information, education information, and other related information. BCforward will only use this information to complete the recruitment process.

This posting is not an offer of employment. All applicants applying for positions in the United States must be legally authorized to work in the United States. The submission of intentionally false or fraudulent information in response to this posting may render the applicant ineligible for the position. Any subsequent offer of employment will be considered employment at-will regardless of the anticipated assignment duration.