SHIFT: Day Job
Your Talent. Our Vision. At Beacon Health Options, a proud
member of the Anthem, Inc. family of companies, its a powerful
combination. Its the foundation upon which were 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.
For more than 30 years, Beacon Health Options has changed the
way people live with behavioral health conditions. Today, we are
the undisputed leader in behavioral health management, serving 37
million people across all 50 states. At Beacon, our mission is to
help people live their lives to the fullest potential. Beacon
offers superior clinical mental health and substance use disorder
management, a comprehensive employee assistance program, work/life
support, specialty programs for autism and depression, and
insightful analytics to improve the delivery of care.
Location: Remote to the United States with preference to
Work Hours: Mon Fri 8:00 am 5:00 pm MST
Primary duties may include, but are not limited to:
Participates in on-site quality external audits such as Care
Coordination, EQRO, accreditation, and regulatory and prepares
audits of required documents; audits will be virtual during
COVID-19 pandemic and on-site audits will be revisited when public
health crisis status changes.
Provides recommendations for primary care practice transformation
and quality improvement activities including selection of valid and
reliable integrated care process and outcome indicators and
coordinates monitoring and evaluation activities with colleagues
and providers Reviews quality and performance data and prepares
concise, accurate and meaningful quality management reports in
accordance with Company procedures.
Identifies opportunities for improvement through review of trend
analyses and performance measurement reports and presentations and
communicates information to colleagues and clients
Assists in implementation and monitoring of quality improvement
projects including, but not limited to the development of practice
transformation and integrated health care practices such care
management programming, and health outcomes improvement activities
such as member education and outreach interventions, provider
education and outreach interventions, client chart reviews, and
performance improvement projects (PIPs).
Performs quality assurance activities on monthly, quarterly, annual
and ad hoc bases, including chart reviews in relation to medical
necessity and contract compliance.
Conducts quality of care investigations and using criteria closes
case appropriately or refers to Quality Management Director or
Chief Medical Officer for further review.
Prepares cases for Quality of Care Committee (QOCC) case
presentations in relation to integrated health care service
delivery and care coordination issues.
Conduct contract-required quality reviews to ensure compliance with
policies, state and federal standards and client performance
standards and participate in other monitoring assignments as
required (i.e., Crisis Program, Care Coordination).
Works with Director of Crisis System Program and staff of Clinical,
Provider Relations and QM Departments to establish and maintain
processes for regular treatment record reviews (mental health,
substance use, hospital, residential, care coordination and others
Conduct contractual audits (Crisis System, Care Coordination, 411,
EQRO), treatment record audits; and compile and report results.
Identify trends and patterns of deficiencies within practices,
evaluate results, identify and communicate areas for improvement
Identify specific areas of focus for treatment record audits and
provider training/education annually; evaluate results, identify,
and communicate areas for improvement within the system.
Conduct and track adverse incident and quality of care issue
investigations as needed; attend associated meetings and
Lead assigned meetings; participate in State, client and
provider/facility meetings and performance improvement initiatives
(PIPs, behavioral health, KPI measures) as directed.
Knowledge of crisis system (preferably has worked in crisis
services before) Knowledge/experience developing and implementing:
Performance Outcome Plans Quality Improvement Plans Corrective
Current unrestricted RN (preferred), LCSW, LMFT, LPC or Clinical
Psychologist license in applicable state(s) required.
2 years of experience in health care quality improvement and/or
integrated care, behavioral health, risk management and/or
utilization review in a managed care setting; or any combination of
education and experience, which would provide an equivalent
RN, LCSW, LMFT, LPC or Clinical Psychologist; BA/BS degree in
nursing, social work, counseling or behavioral health field with
background and skills in quality management and experience in
practice transformation and/or integration care settings.
Experience in conducting audits within a managed care health plan
If not located in Colorado - travel to Colorado will be
Applicable to Colorado Applicants OnlyAnnual Salary Range*:
$64,800 81,000 Actual compensation may vary from posting based on
geographic location, work experience, education and/or skill level.
* The hourly or salary range is the range Anthem in good faith
believes is the range of possible compensation for this role at the
time of this posting. The Company may ultimately pay more or less
than the posted range. This range is only applicable for jobs to be
performed in Colorado. This range may be modified in the future. No
amount is considered to be wages or compensation until such amount
is earned, vested, and determinable under the terms and conditions
of the applicable policies and plans. The amount and availability
of any bonus, commission, benefits, or any other form of
compensation and benefits that are allocable to a particular
employee remains in the Company's sole discretion unless and until
paid and may be modified at the Companys sole discretion,
consistent with the law. 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. An Equal Opportunity
Anthem, Inc. is ranked as one of Americas Most Admired Companies
among health insurers by Fortune magazine and has been named a 2019
Best Employers for Diversity by Forbes. To learn more about our
company and apply, please visit us at careers.antheminc.com. An
Equal Opportunity Employer/Disability/Veteran. Anthem promotes the
delivery of services in a culturally competent manner and considers
cultural competency when evaluating applicants for all Anthem