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Market Clinical Quality Specialist Ii - Ga Based And Licensed Rn

Company

CareSource
Address , , Ga
Employment type FULL_TIME
Salary $66,700 - $106,700 a year
Expires 2023-10-03
Posted at 9 months ago
Job Description
Job Summary:
The Market Clinical Quality Specialist II completes assigned case/file reviews to ensure adherence to regulatory requirements and identified Standard Operations Procedures (SOPs)..
Essential Functions:
  • Continuously pursue and identify best practices as well as opportunities for improvement and facilitate implementation of improvement initiatives for health services monitoring and accreditation
  • Perform any other job related instructions as requested
  • Provide cross-functional assistance to meet monitoring, accreditation and operational responsibilities to ensure adherence to regulatory requirements
  • Maintain familiarity with all applicable Federal and State Requirements, which include the Corporate Integrity Agreement responsibilities; also responsible for monitoring changes within those requirements, identifying the areas that will be impacted, communicating the changes and assisting with implementation of the changes
  • Assist Management with reporting of case reviews that can be communicated at overall aggregate and individual contributor levels
  • Subject matter expert (SME) in assigned area(s)
  • Ensure compliance with adherence to regulatory requirements and identified Standard Operating Procedures (SOPs) through monthly inter-rater reliability monitoring of case reviews
  • Participate in interdepartmental meetings/workgroups, as directed, to ensure that new operational procedures and updates to existing procedures for Care Management (CM) are compliant with contract requirements
  • Identify departmental training and development opportunities and work collaboratively with peers and Care Management to develop the needed education and/or training
Education and Experience:
  • Associate of Science in Nursing (ASN) is required
  • Bachelor of Science in Nursing (BSN) is preferred
  • Minimum of three (3) years of diverse clinical experience as an RN is preferred
  • One to three (1 to 3) years of experience in Quality Improvement, Project Management, Case Management or Utilization Review is required
Competencies, Knowledge and Skills:
  • Intermediate in Microsoft Excel, Access and Word
  • Familiarity of the healthcare field
  • Knowledge of Medicaid and Medicare
  • Effective listening and critical thinking skills
  • Strong written and verbal communication skills Ability to work independently and within a team environment
  • Intermediate skill level with SharePoint
  • PowerPoint and Visio preferred
  • Strong interpersonal skills and high level of professionalism
  • Ability to coordinate complex projects and multiple meetings
  • Ability to work with a variety of disciplines and levels of staff across departments
  • Ability to develop, prioritize and accomplish goals
  • Technical writing skills
  • Effective problem solving skills with attention to detail
Licensure and Certification:
  • Current, unrestricted Registered Nurse (RN) licensure in state of practice, is required
  • Case Management Certification, such as Certified Case Manager (CCM) through the Commission for Case Management Certification (CCMC), is highly preferred
Working Conditions:
  • General office environment; may be required to sit or stand for extended periods of time
Compensation Range:
$66,700.00 - $106,700.00
Compensation Type (hourly/salary):
Salary
Organization Level Competencies
  • Develop Self and Others
  • Drive Execution
  • Create an Inclusive Environment
  • Understand the Business
  • Pursue Personal Excellence
  • Cultivate Partnerships
  • Influence Others

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer, including disability and veteran status. We are committed to a diverse and inclusive work environment.