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Clinical Quality Auditor Sr. - In office and Remote (up to 30%) in Fresno, CA but also open to Central Valley, CA - PS6236 in Fresno, CA at Anthem, Inc.

Date Posted: 5/10/2018

Job Snapshot

Job Description

Your Talent. Our Vision. At Anthem Blue Cross, a proud member of the Anthem, Inc. family of companies,  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 health care. This is an exceptional opportunity to do innovative work that means more to you and those we serve.
RN Clinical Quality Auditor Sr. – In office or Remote (up to 30%) in Fresno, CA but open to Central Valley area applicants.
$3,000 Sign on Bonus for this position.
RN Clinical Quality Auditor Sr, is responsible for coordinating Quality Management (QM) activities related to compliance and accreditation for an assigned SBU.
Primary duties may include, but are not limited to:
  • Develops and maintains pertinent compliance plans.
  • Monitors adherence to plans and prepares status reports.
  • Conducts audits, identifies training and communication needs, and implements related programs with Providers
  • Ensures all policies and procedures are updated as legislation or accreditation standards change.
  • Implements standardization of procedures and documentation within SBU.
  • Develops and delivers executive level presentations and represents senior management on compliance issues and related committees.
  • Requires a BA/BS; 3 years of compliance, audit or quality improvement experience; or any combination of education and experience, which would provide an equivalent background.
  • Experience with regulatory/accreditation audits and knowledge of regulatory/accreditation standards in a health or managed care environment is preferred.
  • Requires a current unrestricted California RN license
  • Experience with Facility Site Reviews and Medical Record Review is preferred
  • HEDIS and audit experience is preferred
  • Medicaid experience is preferred
  • Ability to travel to Provider offices and conduct audits, trainings, etc.
  • Ability to travel overnight maybe required (the possibility of 1 or 2 nights a month)
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine, and is a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company please visit us at  EOE.M/F/Disability/Veteran.


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