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Quality Manager (Remote U.s.)
Company | Acentra Health |
Address | United States |
Employment type | FULL_TIME |
Salary | |
Category | Health and Human Services |
Expires | 2023-09-28 |
Posted at | 8 months ago |
Description
- Are you an experienced Quality Manager looking for a new challenge?
- Are you looking to join a team that ensures a collaborative and inviting culture where everyone can thrive?
- Under general supervision of the Program Director and in collaboration with the administrative team and Medical Director, the Quality Manager oversees the department responsible for internal and external Quality Review processes in accordance with the goals of the Colorado HCPF Utilization Management Contract.
- The Quality Manager also assists with the development of requirements for system configuration and reports.
- Oversee contract-specific Quality Program, providing guidance to the management team and client regarding quality-related issues.
- Consult with other program managers and supervisors regarding member and/or provider complaints and grievances as needed.
- Work collaboratively with clients and stakeholders to develop process improvements.
- Focus on risk management, operations and infrastructure, performance monitoring and improvement, and consumer protection and empowerment in the day-to-day management of quality assurance activities for the contract.
- Manage program staff IRR and clinical documentation audit processes.
- Ensure that the program meets or exceeds all contract Performance Standards.
- In collaboration with the Program Director, UM Manager, and clinical supervisors, responsible for the quality monitoring activities, including identifying areas of improvement and plan implementation of improvement areas.
- Verify adverse decision notifications were handled and documented per the policies of the state of Colorado.
- 3+ years of experience working with external clients and customers.
- 2+ years of experience in data collection, process improvement, ensuring quality measures/metrics, and template creation for public notices, training, and surveys.
- 3+ years of experience in Utilization Management (UM) / Utilization Review (UR).
- Bachelor’s degree in Nursing.
- 2+ years of experience recommending, developing, and reviewing quality assurance standards, policies, and procedures in accordance with company standards.
- 3+ years of experience in quality management and project management.
- An active, unrestricted Registered Nurse (RN) license in any U.S. state.
- Experience working in a Fee-for-Service (FFS) or Managed Care Medicaid quality role.
- Experience with State Medicaid programs.
- Master’s in Nursing or another health-related field.
- Experience in services such as DME, Medical/Surgical, Psych/BH, Pediatric Home Health/PDN, Physician Administered Drugs, and other outpatient services.
- Knowledge of Colorado Medicaid.
- 3+ years of experience working with a Medicaid population.
- 5+ years of experience in quality management and project management.
- Certified Professional in Healthcare Quality (CPHQ).
- Ability to maintain a positive attitude and contribute both as an individual and a team member to achieve the goals of the department.
- Knowledge of National Committee for Quality Assurance (NCQA) / Utilization Review Accreditation Commission (URAC) standards.
- Highly organized.
- Excellent verbal and written communication skills.
- Sets high standards of performance for self and others and assumes responsibility and accountability for successfully completing assignments or tasks.
- Ability to professionally respond to change and handle multiple and changing priorities with sometimes conflicting deadlines.
- Knowledge and willingness to become a subject matter expert and thought leader for the designated program(s).
- Demonstrated proficiency in MS Office applications.
- Excellent customer service skills.
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