Quality Review & Monitoring Supervisor - 00056517

Description

Pay Grade: N

The Georgia Department of Community Health (DCH) is one of Georgia's four health agencies serving the state's growing population of over 10 million people. DCH serves as the lead agency for Medicaid, oversees the State Health Benefit Plan (SHBP) and Healthcare Facility Regulation, impacting one in four Georgians.

Through effective planning, purchasing and oversight, DCH provides access to affordable, quality health care to millions of Georgians, including some of the state's most vulnerable and under-served populations. Six enterprise offices support the work of the agency’s three program divisions. DCH employees are based in Atlanta, Cordele and across the state.

DCH is committed to providing superior C*ustomer Service and Communication, embracing Teamwork and fostering A*ccountability to ensure that our internal and external customers and stakeholders feel included, respected, engaged and secure. DCH is currently seeking a qualified candidate for the Quality Review and Monitoring Supervisor position in the Performance, Quality & Outcomes (PQO) Unit within the Performance & Care Management Office of the Medical Assistance Plans (MAP) Division. The MAP Division, which accounts for approximately three billion dollars annually of the State's budget, is dedicated to advancing the health, wellness, and independence of those they serve by providing access to quality care and resources statewide to approximately 1.7 million Georgians. The position is based in Downtown Atlanta, GA (Fulton County). The position reports to the Director of Population Health and Quality Planning. This is a hybrid position that requires in-office and remote work with the approval of your supervisor. Your days of frequency in the office can change at any time during your employment based on the business needs of the organization.

Job Responsibilities

Responsible for reviewing and monitoring adherence to quality and clinical regulatory
requirements related to the Georgia Medicaid Quality Program, including federal and state
standards of care, clinical effectiveness, communications of compliance, and policy language
development. Works closely with the Quality Analytics team to monitor the timeliness and
accuracy of the reporting of quality of care, and to identify areas for improvement by CMOs
contracted by Georgia, the waiver programs, state agencies, and providers responsible for
administering health care services.

ESSENTIAL DUTIES and RESPONSIBILITIES:
1. Report to Performance & Care Management Deputy Executive Director on activities and initiatives, including escalating any risks, issues, or concerns
2. Establishes an approach and infrastructure necessary to effectively oversee the review and monitor adherence to quality and performance improvement requirements

• Develops, implements, and maintains a formal compliance structure and filing system for compliance materials.
• Ensures the strategic review of quality related reports. Develops and implements a compliance work plan such that the elements of an effective compliance program are appropriately in place and that the compliance work plan is executed appropriately.
• Creates the structure, processes, and tools necessary to facilitate regulatory report filings, state requested ad-hoc deliverables, and related activities.
• Oversees quality and performance improvement reviews and identifies lack of compliance, potential risks, and recommended corrective actions

3. Supervise Quality Review and Monitoring staff

• Hiring, on-boarding, managing, and training staff to drive performance and engagement.
• Managing and coaching staff to stay current with regulations, provide timely and efficient reviews, and overcome review implementation roadblocks.
• Maintain thorough knowledge of applicable federal and state programmatic and statutory requirements as they apply to regulatory reviews

Minimum Qualifications

Master's degree in a related field from an accredited college or university AND Three years of related experience, One year of which in a supervisory position OR Bachelor's degree in a related field from an accredited college or university AND Five years of related experience, Two years of which in a supervisory position OR Associate's degree in a related field from an accredited college or university AND Six years of experience, Two years of which in a supervisory position related to the area of assignment OR Two years of experience required at the lower level Compliance Specialist 3 (RCP062) or a position equivalent. Note: Some positions may require a certification or licensure. Note: Some positions may require a valid driver's license.

Key Skills and Qualifications:

• Experience coordinating, implementing, and evaluating healthcare reporting processes.
• Demonstrated knowledge, and understanding of population health and outcomes
• Strong knowledge of healthcare terminology
• Strong written and oral communication/presentation skills
• Experience reviewing or auditing healthcare related records or reports.

Preferred Qualifications:

• Significant knowledge and understanding of federal, state, and CMS regulations.
• Significant experience researching for evidence and best practice care
• Proficient with MS Word, Excel, data analysis and visualization
• Experience working with Medicaid or a Care Management Organization (CMO)

Additional Information

EARN MORE THAN A SALARY! In addition to a competitive salary, the Georgia Department of Community Health offers a generous benefits package, which includes employee retirement plan; paid holidays annually; vacation and sick leave; health, dental, vision, legal, disability, accidental death and dismemberment, health and child care spending account.

Due to the volume of applications received, we are unable to provide information on application status by phone or e-mail. All qualified applicants will be considered, but may not necessarily receive an interview. Selected applicants will be contacted by the hiring agency for next steps in the selection process. Applicants who are not selected will not receive notification.

THIS POSITION IS SUBJECT TO CLOSE AT ANY TIME ONCE A SATISFACTORY APPLICANT POOL HAS BEEN IDENTIFIED. APPLICATIONS WITHOUT WORK EXPERIENCE LISTED WILL NOT BE CONSIDERED. CURRENT GEORGIA STATE GOVERNMENT EMPLOYEES WILL BE SUBJECT TO STATE PERSONNEL BOARD (SPB) RULE PROVISIONS. THE POSITION MAY BE FILLED AT A LOWER OR HIGHER POSITION LEVEL.

This position is unclassified and employment is at-will. Candidates for this position are subject to a background history and reference check. For more information about this job

contact: : http://dch.ga.gov

Job Type: Full-time

Pay: $57,331.12 - $81,000.00 per year

Benefits:

• Dental insurance
• Flexible schedule
• Paid time off
• Professional development assistance
• Health insurance
• Vision insurance
• 401(k)
• 401(k) matching

Schedule:

• 8 hour shift
• Monday to Friday

COVID-19 considerations:
Wear masks, sanitize stations available, social distancing practiced.

Ability to commute/relocate:

• Atlanta, GA 30303: Reliably commute or planning to relocate before starting work (Required)

Experience:

• Customer service: 1 year (Preferred)
• Pharmacy technician experience: 1 year (Preferred)

License/Certification:

• Pharmacy Technician License (Preferred)
• Pharmacy Technician Certification (Preferred)

Work Location: In person