What are the responsibilities and job description for the Clinical Quality Assurance Advisor position at Elevance Health?
The Clinical Quality Assurance Advisor is responsible for evaluating clinical and quality performance by monitoring calls and correspondence of the EAP Consultants. Ensures the delivery of excellent service to internal and external customers. Keeps management apprised of critical service quality issues, ensures staff receives appropriate training and performance feedback and provides management with recommendations regarding staff development.
Primary duties may include, but are not limited to :
Monitors, evaluates and documents participant or provider calls for designated staff to ensure staff responses meet clinical and quality audit standards, and provides managers and EAP Consultants with call coaching quality data.
Partners with management to ensure frequent performance and developmental feedback are provided to staff.
Compiles and reports monitoring evaluation data and presents call coaching sessions.
Provides staff with an action plan for process improvement.
Gathers documentation regarding non-compliance in meeting required standards and provides to management for use in the corrective action process.
Contributes to performance improvement plans.
Ensures processes are in place to support adherence to all state and federal laws (HIPAA), regulatory requirements, accrediting agencies (NCQA and URAC), as well as company clinical criteria and policies and procedures.
Compiles and presents summary level call coaching and efficiency data for management to use for performance reviews.
Assures integrity and confidentiality of call monitoring documentation and evaluates / develops monitoring tools to support efficiency and effectiveness in the call monitoring process. Audits the timeliness and accuracy of follow up inquiries.
Measures the ability of staff to successfully meet all client performance expectations and presents final assessments to management.
Identifies improvements or training opportunities and develops / presents quality improvement training materials to improve overall service quality.
Identifies trends in inquiry monitoring and recommends actions to meet business needs.
Develops ideas for performance improvement, service delivery, and cross-functional initiatives.
Collaborates with management on new client implementation activities, including development / presentation of training materials, to ensure home service center and client performance expectations are met.
Position requirements :
- Requires MA / MS in Social Work Counseling or one of the other core mental health disciplines and a minimum of 3 years post graduate relevant work experience as well as a minimum of 1 year of experience performing an EAP Consultant role; or any combination of education and experience which would provide an equivalent background.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient / member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.
