WellPoint is one of the nation's leading health benefits companies and a Fortune Top 50 company. At WellPoint, we are working together to transform health care with trusted and caring solutions. Bring your expertise to our innovative culture where you will have the opportunity to make a difference in people’s lives, and to take your career further than you can imagine.
This position is located in Fresno, CA and may be a work at home.
Responsible for participating in Quality Management (QM) activities that ensure programs meet accreditation and regulatory standards. Primary duties may include, but are not limited to: Prepares QM Department for oversight audits. Prepares corrective action plans in response to oversight body's request. Conducts audits of QM processes and files. Writes policies and procedures. Assists with development of provider manuals, audit tools, and guidelines. Coordinates flow of information and documentation between associates responsible for day-to-day activities related to accreditation or regulatory reviews. Develops and implements accreditation and regulatory review tracking system. Maintains accreditation and/or regulatory review compliance library. Creates audit tools, reports, standardized policies and procedures, and provider manuals. Facilitates implementation of survey or regulatory recommendations. Assesses and evaluates progress towards meeting standards. Recommends new process. Trains associates on new and revised standards. Compiles documentation for presentation to accrediting/regulatory organization.
Requires an AS in Nursing; 5 years of experience in a healthcare setting including 3 years of quality management experience and/or experiencing preparing for regulatory/accreditation audits; or any combination of education and experience, which would provide an equivalent background. Current unrestricted California RN license required. Knowledge of regulatory/accreditation standards required. BSN is preferred. Ability to travel may be required. HEDIS experience preferred.
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/D/V.
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