Provider Quality Specialist II
About The Position
This rewarding opportunity is perfect for someone who enjoys team collaboration and being part of a mission driven organization. Community Care’s mission is to help elderly individuals and adults with physical and intellectual disabilities continue to live as independently as possible in the community. Mid to North Wisconsin Territory is the primary area covered with potential travel to outlying counties as required by provider and member location. Flexibility of candidate is crucial as our network needs and development are constantly changing. The team does realign territory as our network needs change and expand. The Hub for this position is Sheboygan. Flexibility is required as provider locations are across the whole state. Some remote work. Travel to provider and CCI office sites required. Other locations may be used for department and team in-person meetings. Along with the Provider Management/Provider Quality team and under the direction of the Provider Quality Manager a variety of job responsibility and opportunities exist.
Requirements
- Bachelor's Degree in a related field; or 5 years of related work within an Managed Care Organization (MCO), residential or health care entity.
Nice To Haves
- Residential operations, Licensing or certification of facilities with strong knowledge of regulations.
Responsibilities
- Conducts pre-contract and quality provider visits.
- Performs certification of 1-2 Bed Adult Family Homes
- Provides technical assistance to providers and to support and ensure quality of care
- Collaborate with providers, teams and external entities such as DQA, DHS, APS and police as it relates to incidents involving contracted providers
- Monitors overall quality of provider network
- Prepares reports, conducts investigations, maintains documentation, reviews DQA Statements of Deficiencies, Background checks, Staff Service Delivery Concerns and creates follow up plans
- Ability to function independently and collectively with Provider Quality team to ensure provider expectations and regulatory guidelines are consistently applied
- Attends team and department meetings at the other Locations
- Performs other job related duties as assigned.
Benefits
- Attractive full and part time schedules
- Generous paid time off
- Competitive pay and benefits (health, dental, vision, etc.)
- Retirement Plan with employer contribution
- Flexible benefits plan
- Employee referral program
- Co-Workers care program
- Employee Assistance Program
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
