- Manages the development, approval, implementation and compliance of on-going external client facing programs; develops program budget; ensures program meets its stated objectives; provides subject matter expertise in response to day to day business issues.
- Researches applicable subject matter practices and remains aware of industry trends.
- Manages relationships and partners with corporate and regional business areas; coordinates training related to the external client facing program; develops program success measures and performs periodic assessments of external client facing program success.
- Makes a report to Adult Protective Services (APS) for incidents involving suspected abuse, neglect, or exploitation
- Makes a referral to Grievance and Appeals when a potential quality of care concern is identified
- Notifies the Member Privacy Unit (MUP) of privacy disclosures when external agencies such as law enforcement are contacted
- Identifies potential cases of fraud, waste, and abuse and makes appropriate referrals
- Manages regulatory reporting related to critical incidents including weekly reporting to the State partner
- Tracks and responds to untimely reporting of critical incidents
- Tracks and trends critical incident data on a monthly, quarterly and annual basis and identifies opportunities for improvement in protecting the health, safety, and welfare of members
- Collaborates with Network Relations, Quality, and Grievance and Appeals on identifying and supporting provider corrective action plans
- Collaborates with the State partner in analyzing critical incident patterns and trends
- Data mines and reviews claims reports to identify potentially unreported critical incidents. Completes critical incident reporting for unreported incidents.
- Provides education to the care coordination team in coordination with the training specialist in recognizing and screening for signs of abuse, neglect and exploitation (ANE); identifying individuals at risk of ANE; reporting ANE and critical incidents; and providing members and caregivers educational materials and resources on ANE.
- Stays up-to-date on industry standards and requirements for ANE and critical incident reporting and prevention.
- Participates in review and audits conducted by the State partner of the critical incident process which may include reviewing policy and procedures, workflows, and data.
- Requires a BA/BS in a related field and minimum of 3 years experience in external client facing program management; or any combination of education and experience, which would provide an equivalent background.
- For the Behavioral Health organization, lived experiences with behavioral health programs is strongly preferred.
- Graduate degree, professional designation related to field or project management experience preferred.
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Critical Incident Consultant - Indianapolis, United States - Elevance Health
Description
Anticipated End Date:Position Title:
Critical Incident Consultant
Job Description:
Location: This position will work a hybrid model (remote and office). Ideal candidates will live in the state of Indiana and reside within 50 miles the PulsePoint on 220 Virgina Ave.
Responsible for the development and ongoing management of one or more external client facing programs within a business unit. Program consultants typically support business strategies through an integrated portfolio of external client facing projects or initiatives.
Primary duties may include, but are not limited to:
Non-Management Exempt
Workshift:
Job Family:
BSP > Program/Project
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact for assistance.
