Supervisor, Continuous Quality Monitoring

Regal Medical Group•Los Angeles, CA

About The Position

CQM Supervisor manages CQM non-clinical auditors to monitor the regulatory compliance and quality of process in daily Non-Clinical Utilization Management (UM) activities under supervision of manager. The Supervisor will be responsible for UM case file live audit including assign driver and presenter and ensure their appropriately performance. The Supervisor will be responsible for UM system control monitoring and UM process monitoring especially the process not requiring clinical decisions. This position requires knowledge of comprehensive regulation, UM policies & procedures, UM system, UM audit and quality improvement.

Requirements

Graduate from high school or above.
Three to five (3-5) years of utilization management (non-clinical) experience.
Minimum two (2) years of UM supervision (non-clinical) or UM auditor (non-clinical) experience preferred.
Proficient in MS Office programs (i.e., Word, Excel, Outlook, Access, and Power Point).
Typing 60 words per minutes with accuracy.
Ability to deal with responsibility with confidential matters.
Must have strong analytical, creative problem solving, and organizational skills.
Ability to work in a multi-task, high stress environment.
Ability to strategize effectively, execute within timelines, and deliver quality results
Ability to thrive in a fast-paced environment where flexibility and being proactive are essential
Must be able to handle multiple projects at one time, reset priorities day-to-day to meet deadlines, and know when to ask for assistance and direction when working with conflicting priorities.
Must be self-motivated, pleasantly aggressive and realistically ambitious and have high personal ethics.
Must have the ability to work with all levels of management and have the ability to develop positive working relationships with different divisions in the company.

Responsibilities

The role must be familiar with Non- Clinical UM regulations, Non-Clinical UM process and Non-Clinical UM system.
The role is good at assign workload with management skills.
Good at presentation case files and handle interview for nonclinical questions.
Good at design audit tool to monitor Non-Clinical UM process done by nonclinical staff.
Good at communication with internal clients and external customers.
Good at training employees by using P&Ps, audit tools.
Good at providing constructive feedback and active communication skills.
Summarize the quality monitoring findings, analyze root causes and propose of quality improvement plans.
Suggest and design focus audits that might be help Non- Clinical UM improve the compliance of process.
Request decision support to create and improve the Non-Clinical UM monitoring reports based on UM P&Ps changes.
Ensure auditors complete audits and remediation within required timeframes.
Collaborate with Non-Clinical UM team to ensure any focus audited area being monitored, and the quality of process being tracked.
Work with operational teams to monitor the effectiveness and efficiency of the process change made for quality improvement.
Ensure new process procedure being implemented accurately through reports and case files review.
Report issues found to prior authorization compliance director based on findings.
Review updated policy and procedure, be able to update the quality monitoring tool based on the policy and procedures. .
Keep all evidence of quality monitoring projects.
Maintain and track daily reports received from decision support team.
Report issues related to internal processes (i.e. timeliness issues) to the CQM manager.
Attend department meetings, in-house service, trainings and complete acknowledgement within required timeframe.
All other duties as directed by management.