Clinical Quality Management Analyst
Job Description:
• Evaluates, analyzes and monitors staff or provider performance to achieve excellence in quality
• Provides timely, relevant, accurate, and objective feedback to staff, providers, and the management team which includes a plan of action or recommendations when deficiencies are identified
• Acts as technical resource and develops learning solutions that engage the learner and produces desired business goals and objectives
• Performs quality audits of staff/providers to ensure compliance with departmental plans and regulates policies and procedures
• Assists in designing effective learning solutions based on analysis of quality audit results when quality deficiencies are identified
• Monitors and reports on individual and department results to include benchmarking and trending
• Acts as a day-to-day resource for technical assistance and clinical decision making
• Provides guidance with interpretation of clinical aspects of Corporate Medical Policy and other clinical guidelines to assist in making medical decisions
• Aligns clinical decision-making processes with regulatory requirements (e.g. DOI/ERISA/NCQA)
• Keeps abreast of medical knowledge, care patterns, regulatory and governmental rules and regulations
• Works with management team to support decisions on workflow process, quality improvement, goal setting and data driven information-based decision-making
• Provides timely feedback to management on staff/provider performance
• Acts to facilitate change efforts and promote department, division and corporate goals
• Assist with maintenance of Web Content Management System (WCMS) and may collaborate with other areas to maintain SOP’s
• Assists staff with resetting of passwords and set up of new users for vendor electronic messaging
Requirements:
• RN with 3 years of clinical experience or LPN with 5 years of clinical experience required
• Must have previous work experience in applicable business area (i.e. UM, CM, Medical Review or quality programs)
• Bachelor's degree or advanced degree preferred
Benefits:
• Medical, dental, and vision coverage along with numerous health and wellness programs
• Parental leave and support plus adoption and surrogacy assistance
• Career development programs and tuition reimbursement for continued education
• 401k match including an annual company contribution
• Work-life balance, flexibility, and the autonomy to do great work
Apply Now
Apply Now
• Evaluates, analyzes and monitors staff or provider performance to achieve excellence in quality
• Provides timely, relevant, accurate, and objective feedback to staff, providers, and the management team which includes a plan of action or recommendations when deficiencies are identified
• Acts as technical resource and develops learning solutions that engage the learner and produces desired business goals and objectives
• Performs quality audits of staff/providers to ensure compliance with departmental plans and regulates policies and procedures
• Assists in designing effective learning solutions based on analysis of quality audit results when quality deficiencies are identified
• Monitors and reports on individual and department results to include benchmarking and trending
• Acts as a day-to-day resource for technical assistance and clinical decision making
• Provides guidance with interpretation of clinical aspects of Corporate Medical Policy and other clinical guidelines to assist in making medical decisions
• Aligns clinical decision-making processes with regulatory requirements (e.g. DOI/ERISA/NCQA)
• Keeps abreast of medical knowledge, care patterns, regulatory and governmental rules and regulations
• Works with management team to support decisions on workflow process, quality improvement, goal setting and data driven information-based decision-making
• Provides timely feedback to management on staff/provider performance
• Acts to facilitate change efforts and promote department, division and corporate goals
• Assist with maintenance of Web Content Management System (WCMS) and may collaborate with other areas to maintain SOP’s
• Assists staff with resetting of passwords and set up of new users for vendor electronic messaging
Requirements:
• RN with 3 years of clinical experience or LPN with 5 years of clinical experience required
• Must have previous work experience in applicable business area (i.e. UM, CM, Medical Review or quality programs)
• Bachelor's degree or advanced degree preferred
Benefits:
• Medical, dental, and vision coverage along with numerous health and wellness programs
• Parental leave and support plus adoption and surrogacy assistance
• Career development programs and tuition reimbursement for continued education
• 401k match including an annual company contribution
• Work-life balance, flexibility, and the autonomy to do great work
Apply Now
Apply Now