Company: Wellpoint
– WellPoint, Inc. was formed when WellPoint
Health Networks, Inc. and Anthem, Inc. merged in
2004 to become the nation’s leading health
benefits company. WellPoint, Inc. is the largest
health benefits company in terms of commercial membership
in the United States.
Description: Responsible
for developing and implementing quality programs
to assess health care professionals and monitor compliance
and accreditation standards.
Responsible for developing and implementing quality
programs to assess health care professionals and
monitor compliance and accreditation standards.
Primary
duties may include, but are not limited to:
-Develops,
implements, and analyzes existing processes relating
to on-site review of physician offices.
-Develops
standard assessment and documentation tools to ensure
compliance with accreditation standards.
-Manages
activities involving participating healthcare professionals
to ensure that Anthem's members receive quality care
through formal physician presentations, partnering
with network management, marketing, and other areas.
-Assists with the regional HP/DSM's in the development
of guidelines and programs and interventions and
collecting data for clinical quality improvement
projects.
Qualifications:
-Requires current unrestricted RN license in applicable
state(s) and 3 - 5 years clinical experience as well
as managed care or clinical quality improvement experience
or any combination of education and experience, which
would provide an equivalent background.
-BSN
preferred.
-Knowledge of NCQA, state and federal
regulations, knowledge of health care delivery system,
and knowledge of QA and continuous quality improvement
principles.
-Ability to travel required.
Please
click below to apply.
