Clinical Quality Compliance Admin Lead FEP RN required 64802
WellPoint - Indianapolis, IN

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Team Lead for the FEP Clinical Quality Administration. Responsible for leading a team of who monitor and evaluate clinical and non-clinical contact between program staff and participants, assessing adherence to protocols and appropriate clinical interaction, and ensuring calls are evaluated for safety, clinical effectiveness, productivity and customer service. Primary duties may include, but are not limited to:

Assists manager with day-to-day monitoring and prioritizing of workflows and activities. Develops and improves departmental processes, procedures and operations.

Monitors local Quality Evaluator time, performance and processes. Conducts performance audits on Quality Evaluator activities.

Assists with issues of non-compliance on the local QE team.

Mentors and coaches staff to accomplish assigned projects and job functions.

Assists with the training of new associates and re-trains current associate(s) as needed.

Monitors Quality Evaluators and prioritizes shift workflows, including adjustments, and assigns mentoring requests.

Meets regularly with Care Center Quality Evaluation Team as well as the Learning team in order to stay informed to changes in protocols, policies and/or processes.

Serves as knowledge and resource expert for assigned functions and projects.

Highly prefer candidate with strong experience working in FEP Clinical Quality area.

P osition limited to Indianapolis, Roanoke & Richmond Virginia and Columbus GA locations

Job Qualifications

Elevates team member performance issues to manager. Requires a current unrestricted license in applicable state(s) RN, License and 5 years of experience in managed care including at least 2 years of experience in clinical staff education/training, quality; or any combination of education and experience, which would provide an equivalent background. Clinically relevant certification (i.e. Certified Diabetes Educator, Certified Case Manager) and a background in quality or performance improvement preferred.

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. Our company will never ask
you for bank account information when you are applying for a job.

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