Medical-- What do they do at WellPoint?

Become part of the force that is propelling WellPoint toward our goal of improving health outcomes and quality of life for our associates, members and communities.
Become part of the force that is propelling WellPoint toward our goal of improving health outcomes and quality of life for our associates, members and communities. Create and share advanced educational tools that empower individuals to take ownership of their health and wellness. Build upon your diverse clinical skills and experience, while enjoying opportunities for advancement and a more balanced way of life.

Medical professionals at WellPoint:
  • Work independently as well as collaboratively within our team of exceptional nurses, physicians and pharmacists
  • Support the Company's various business units in the development of innovative benefit designs that promote transparency, stability and affordability
  • Show initiative and make key decisions with the potential to dramatically influence patient outcomes and positively impact peoples' lives
  • Ensure members get the support they need before, during and after their medical procedures, while helping to maintain exceptional quality control at every stage of the member relationship cycle

    Physician Executive Fellowship
 
Clin Quality Audit Analyst Sr - 91336SY
CA , Rancho Cordova
CA , Sacramento
CA , San Jose
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See more health care career opportunities available with WellPoint
Job Post Date:   
08/08/2014
Employer:   
WellPoint, Inc
Benefits:   
Job Description

 
WellPoint is one of the nations leading health benefits companies and a Fortune Top 50 company. At WellPoint, we are working together to transform health care with trusted and caring solutions.
 
Bring your expertise to our innovative culture where you will have the opportunity to make a difference in people’s lives, and to take your career further than you can imagine. 
 

Responsible for developing, coordinating, implementing, and evaluating qulity improvement activities for assigne population according to the Quality Managment (QM) program.

 

Primary duties and responsibilities include but not limied to:

 

  • Participates in on site quality external audits such as NCQA 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 using Excel and/or Access 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 medical 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.

Job Qualifications

 
  • Requires a BA/BS in Health Administration or a related clinical field and 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 is required.
  • Current unrestricted California RN license is required.
  • Requires strong PC skills (Word, Excel, Access, PowerPoint and Visio), organizational and data analysis skills.
  • Managed care/Medicaid and/or Medicare experience a plus.
  • Experience with Medical Record Review is preferred.
  • Travel may be required.

 

WellPoint is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine, and is a 2013 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company please visit us at www.wellpoint.com/careers. EOE. M/F/Disability/Veteran.
  

Once an offer is accepted, all external applicants are subject to a background investigation and if appropriate, drug testing. Offers of employment shall be contingent upon passing both the background investigation and drug testing (if required).

*Current WellPoint associates: All referrals must be submitted through the formal associate referral process on WorkNet. Official guidelines for the associate referral program can be found in My HR.

*WARNING :  Please beware of phishing scams that promote work-at-home opportunities and may also pose as legitimate companies. Please be advised that a WellPoint recruiter will never ask you for a credit card or any type of payment as part of consideration for a role with our company. All of our careers require that you first complete an online application on our wellpoint.com/careers web site.

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