Quality, Audit & Training Specialist

Metropolitan Jewish Health System • New York, NY

2d

About The Position

The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and living life on their own terms.
The MJHS Difference
At MJHS, we are more than a workplace; we are a supportive community committed to excellence, respect, and providing high-quality, personalized health care services. We foster collaboration, celebrate achievements, and promote fairness for all. Our contributions are recognized with comprehensive compensation and benefits, career development, and the opportunity for a healthy work-life balance, advancement within our organization and the fulfillment of having a lasting impact on the communities we serve.

Requirements

• Bachelor’s Degree preferred
• Minimum of three years Health Plan experience with one to two years focus on Customer Service, Compliance, A&G, UM, CM or Quality Management
• Knowledge of federal and state Medicare and Medicaid regulatory requirements for Managed Care
• Proficient in Excel, Access, Power Point, Microsoft Office
• Knowledge of membership, claim, and care management systems
• Skilled in record and data review
• Excellent writing skills
• Excellent interpersonal communication skills
• Excellent organizational skills

Responsibilities

• This position is responsible for assuring high quality performance, effectiveness and adherence to internal guidelines and process in compliance with Federal and State regulatory requirements.
• The scope of responsibility is for clinical initiatives coordinated and overseen by Medical Affairs Administration and key quality/compliance indicators for the A&G Department.
• This is accomplished by developing monitoring and auditing tools to review performance, evaluate effectiveness, identify trends and collaborate with business leads to recommend performance enhancements.
• Prepares findings and reports on outcomes for both internal and external clinical initiatives.
• Collaborates with all internal business leads and externally with participating providers of services.
• Working in collaboration with A&G Director, audits to identify areas for performance improvement within staff and/or with system enhancements.
• Provides system training for newly hired A&G staff and updates all when system upgrades are implemented.

Benefits

• Tuition Reimbursement for all full and part-time staff
• Generous paid time off, including your birthday!
• Affordable and comprehensive medical, dental and vision coverage for employee and family members
• Two retirement plans! 403(b) AND Employer Paid Pension
• Flexible spending
• MJHS companies are qualified employers under the Federal Government’s Paid Student Loan Forgiveness Program (PSLF)

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level