Anthem Clinical Quality Nurse Auditor Sr. (UM) PS6662 in Toledo, Ohio

Clinical Quality Nurse Auditor Sr. (UM) PS6662


Location: United States

Field: Medical

Requisition #: PS6662

Post Date: 2 days ago

Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to 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 at one of America's leading health benefits companies and a Fortune Top 50 Company.

Clinical Quality Nurse Auditor (UM)

Responsible for participating in Quality Management (QM) activities that ensure programs meet accreditation and regulatory standards.

Primary duties may include, but are not limited to:

Prepares QM Department for oversight audits.

Prepares corrective action plans in response to oversight body's request.

Conducts audits of QM 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 compliance 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. Experience with Utilization Management strongly preferred.

Current unrestricted RN license in applicable state(s) required.

Knowledge of regulatory/accreditation standards required.

BSN is preferred.

Ability to travel may be required.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at An Equal Opportunity Employer/Disability/Veteran