Quality Evaluator at Elevance Health

Mason, Ohio, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

BS/BA in nursing, social work, respiratory therapy or related clinical field
Minimum of 3 years of experience in managed care, including experience in clinical staff development and education, quality; or equivalent combination of education and experience
Current unrestricted license in applicable state(s) for designated field (i.e. RN, Social Work, Respiratory Therapy)

Responsibilities

Monitor and evaluate clinical and non-clinical contact between program staff and participants, assessing adherence to protocols and appropriate clinical interaction
Evaluate calls for safety, clinical effectiveness, productivity, and customer service
Provide written and/or verbal feedback to program staff to assist with performance improvement and staff development
Develop reporting and identify overall performance trends
Serve as subject matter expert in clinical and non-clinical policies and procedures, use of HMC software, and call processes
Ensure associates meet standard performance criteria and move program participants toward desired levels of engagement or enrollment, program retention, and positive clinical outcomes (e.g., improved health)
Analyze individual and overall trends based on monitoring results and provide recommendations to operations management or learning and development
Provide quality review process training

Skills

Quality Evaluation

Clinical Assessment

Call Monitoring

Performance Feedback

Trend Analysis

Reporting

HMC Software

Training

Nursing

Social Work

Elevance Health

Integrated health services and digital platform

About Elevance Health

Elevance Health focuses on enhancing the health of individuals throughout their lives by evolving from a traditional health benefits organization into a comprehensive health partner. The company serves over 118 million people, providing support at every stage of health through an integrated approach that addresses a wide range of health needs. Their services are backed by advanced capabilities and a digital health platform that streamlines access to care. Unlike many competitors, Elevance Health emphasizes a holistic view of health, aiming to redefine health and improve community well-being. The ultimate goal is to make health improvements accessible to everyone.

Indianapolis, IndianaHeadquarters

1944Year Founded

$309.4MTotal Funding

IPOCompany Stage

Enterprise Software, Social Impact, HealthcareIndustries

10,001+Employees

Benefits

Medical, dental, & vision insurance

401(k) + match

Paid holidays

Paid Time Off

Incentive bonus programs

Stock purchase plan

Life insurance

Wellness Programs

Financial education resources

Adoption & Surrogacy Assistance

Dependent-care Flexible Spending Account (DCFSA)

Parental Leave

Parental Transition Week

Critical Caregiving Leave

Risks

Departure of CFO John Gallina may create a gap in financial leadership.

Lawsuit against CMS over MA Star Ratings could lead to financial penalties.

CareBridge integration may face operational challenges, disrupting service delivery.

Differentiation

Elevance Health integrates whole health approach with digital health platform for comprehensive care.

Acquisition of CareBridge enhances home health services within Carelon division.

Strategic partnership with Clayton, Dubilier & Rice aims to innovate primary care delivery.

Upsides

AI integration in home health services can reduce hospital readmissions and improve outcomes.

Predictive analytics support early disease detection, aligning with Elevance's whole health approach.

Telehealth expansion offers opportunities to reach more patients remotely.

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