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Elevance Health Quality Evaluator - Crisis Line in HINGHAM, Massachusetts

Location: Must live in state of Massachusetts

Job Description Summary:

Responsible to monitor 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.

  • Provide training for new employees and assist them with taking calls. Update training materials as needed.

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 required.

  • Clinically relevant certification and a background in quality or performance improvement preferred.

Preferred Qualifications:

  • Master’s degree

  • Licensed mental health clinician; LPC, LCSW, LCMHC, LMFT

  • Call center experience or crisis line experience