Quality Assurance Manager (Part C)

Tmf/C2C • Austin, TX

17h • Remote

About The Position

Ensures decision makers adjudicate cases accurately by performing quality audits, reviews, and publishing audit results and conducting meetings, providing coaching, and training on quality. This position is located Remote United States.

Requirements

• Associate's degree or 60 or more credit hours towards a Bachelor’s degree from an accredited college or university in healthcare or related discipline
• Five (5) years medical dispute, Medicare appeals or clinical experience in a healthcare setting
• Three (3) years management or supervisory
• Two (2) years of training Medicare Healthcare Professional (or professional specified within or relevant to contract) with demonstrated experience writing or making medical necessity decisions
• Nursing, Physical Therapy, Respiratory Therapy or Occupational Therapy experience; or relevant experience specified within or relevant to contract
• Resided in the United States for a minimum of three (3) years out of the last five (5) years (Per Contract Requirement)

Nice To Haves

• Additional Medicare appeals or clinical experience in a healthcare setting may be substituted for Associate’s degree on a year per year basis.
• Medicare Part C related appeals activities

Responsibilities

• Oversees, plans, and monitors the quality assurance program.
• Oversees, plans, and audits to ensure timeliness, accuracy, and consistency in reconsideration decisions.
• Oversees, develops, and identifies individual and collective training opportunities based on audit findings and/or data analysis of reconsiderations decisions to help improve individual and corporate quality.
• Oversees, plans, prepares, reviews and analyses data to identify problems, trends and improvement opportunities.
• Oversees, plans, and reviews reopened cases and cases from the problem log in order to identify trends and needs for improvement.

Benefits

• Medical, dental, vision, life, accidental death and dismemberment, and short and long-term disability insurance
• Section 125 plan
• 401K
• Competitive salary
• License/credentials reimbursement
• Tuition Reimbursement

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Education Level: Associate degree