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Quality Evaluator

Location: This position will work a hybrid model (remote and office). The Ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations.

Preferred Location: Mason, OH.

The Quality Evaluator is responsible for monitoring and evaluate clinical and non-clinical contact between program staff and participants, assessing adherence to protocols and appropriate clinical interaction. Evaluates calls for these major areas: safety, clinical effectiveness, productivity and customer service.

How you will make an impact:

• Provides written and/or verbal feedback to program staff to assist with performance improvement and staff development.

• Develops reporting and overall performance trend identification.

• Serves as the subject matter expert in the areas of clinical and non-clinical policies and procedures, use of the HMC software and call processes.

• Ensures each associate meets standard performance criteria and ensures associates are moving program participants toward desired levels of engagement or enrollment, program retention and positive clinical outcomes (i.e. improved health).

• Analyzes individual and overall trends based on monitoring results and providing recommendations to operations management or learning and development.

• Provides quality review process training.

Minimum Requirements:

• Requires BS/BA in nursing, social work, respiratory therapy or related clinical field and minimum of 3 years of experience in managed care which includes experience in clinical staff development and education, quality; or any combination of education and experience, which would provide an equivalent background.

• Current unrestricted license in applicable state(s) for designated field (i.e. RN, Social Work, Respiratory Therapy) required.

Preferred Skills, Capabilities, and Experiences:

• Clinically relevant certification (i.e. Certified Diabetes Educator, Certified Case Manager) and a background in quality or performance improvement preferred.