Director Of Quality, Training & Documentation

Director of Quality, Training & Documentation

Carelon Payment Integrity is a proud member of the Elevance Health family of companies, Carelon Insights, formerly Program Integrity, is determined to recover, eliminate, and prevent unnecessary medical claim expense.

Carelon's Payment Integrity org is looking for a Director of Quality, Training & Documentation to join its Complex & Clinical Audit Team and Provider Education . This people leader will manage and develop a team performing the quality, training/onboarding, and documentation/policy/procedures functions for this global team. This team will align with all aspects of the larger Complex & Clinical Audit Team, such as Hospital Bill Audit, Itemized Bill Review, DRG, Coding, Clinical Value Audits, and Ancillary and Specialty Audits. The ideal candidate is a leader with healthcare experience, management experience, and a body of work including building programs and processes related to quality/training/documentation and driving the strategy that connects all three to business outcomes.

Primary duties may include, but are not limited to :

• Ensures departmental objectives are achieved through the effective utilization of resources.
• Directs the daily activities of the Quality Review staff in performing reviews of operational quality issues.

• Directs the evaluation of the quality of standards issued by department, corporate, customer agreements, Blue Cross Blue Shield Association, and various government agencies.

• Ensures deficiencies in compliance are identified and recommendations are prepared as necessary to strengthen the control environment.
• Hires, trains, coaches, counsels, and evaluates performance of direct reports.
• Develops and maintains positive and productive working relationships with company personnel and management and external contacts.
• Completes special projects that are complex, confidential or sensitive in nature.

Requires B.A. in related field; 4 to 5 years experience; or any combination of education and experience, which would provide an equivalent background.

Highly preferred skills and experiences:

• Experience building programs and processes related to quality/training/documentation and driving the strategy that connects all three to business outcomes.

• Leadership experiences managing a team.

• Healthcare experience, preferably related to claims, pre-pay or post-pay audits, clinical audits, or payment integrity.

For candidates working in person or remotely in the below locations, the salary* range for this specific position is $113, 600 to $204,400.

Locations: California; Colorado; Nevada; Washington State; Jersey City, NJ; New York City, NY; Ithaca, NY and Westchester County, NY

In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).

The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

• The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. 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 Company’s sole discretion, consistent with the law