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Clinical Quality Auditor Sr

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Company: WellPoint

Location: Fresno, CA

Date Posted: February 19, 2014

Source: WellPoint, Inc

Anthem Blue Cross is a proud member of the WellPoint family of companies and is one of Californias oldest and largest health insurers. At Anthem, we are dedicated to our mission of improving the health of the people we serve through improved health of Californians and improved access to care. We believe the best health care coverage can actually help people stay healthy.

Bring your expertise to our innovative, performance-focused culture, and you will discover lasting rewards and the opportunity to take your career further than you can imagine.

Responsible for ensuring clinical quality through an audit process. Primary duties may include, but are not limited to:

* Conducts on-site audits of prospective and existing physicians and independent practice groups.
* Ensures that both utilization and quality programs meet criteria.
* Collects and analyzes data to formulate recommendations and solutions based on audit trends and results.
* Compiles and maintains statistical data.
* Prepares reports ...

Anthem Blue Cross is a proud member of the WellPoint family of companies and is one of Californias oldest and largest health insurers. At Anthem, we are dedicated to our mission of improving the health of the people we serve through improved health of Californians and improved access to care. We believe the best health care coverage can actually help people stay healthy.

Bring your expertise to our innovative, performance-focused culture, and you will discover lasting rewards and the opportunity to take your career further than you can imagine.

Responsible for ensuring clinical quality through an audit process. Primary duties may include, but are not limited to:

* Conducts on-site audits of prospective and existing physicians and independent practice groups.
* Ensures that both utilization and quality programs meet criteria.
* Collects and analyzes data to formulate recommendations and solutions based on audit trends and results.
* Compiles and maintains statistical data.
* Prepares reports for management that define and evaluate problems and propose solutions.

Job Qualifications

* Requires a BS in nursing, health sciences, health management or a related clinical field
* 5 years of experience in utilization management, quality assurance and/or plan administration or any combination of education and experience, which would provide an equivalent background.
* Current unrestricted RN license in CA required.
* Must have a 2 years combination of experience in utilization management, case management, and auditing.

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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