Quality Improvement Specialist position at APS Healthcare in Houston

APS Healthcare is at present recruited Quality Improvement Specialist on Wed, 27 Nov 2013 07:11:16 GMT. organization Qualifications: •Bachelor’s degree in a clinical field •Registered Nurse with current licensure in Texas and eligibility to be licensed in other...

Quality Improvement Specialist

Location: Houston Texas

Description: APS Healthcare is at present recruited Quality Improvement Specialist right now, this position will be placed in Texas. More complete informations about this position opportunity please give attention to these descriptions. Universal American is a New York Stock Exchange company with annual revenues of more than $2 billion. Through our family of healthcare companies, we provide health benefits to people covered by Medicare and/or Medicaid. We are dedicated to working collaboratively with healthcare professionals in order to improve the health and well-being of those we serve and reduce healthcare costs.

Well-capitalized and highly entrepreneurial, Universal American has been on the cutting edge of healthcare for more than 21 years. We offer Medicare Advan! tage plans to people with Medicare. We partner with providers ! in Accountable Care Organizations that serve people with Original Medicare. And we provide array of healthcare services to states, municipalities, health plans and other entities in the world of Medicaid. In everything we do, we focus on improving the coordination of healthcare through collaboration between payers, providers and patients to achieve the best health outcomes possible.

For more information on Universal American, please visit our website at www.UniversalAmerican.com.

The Quality Improvement Specialist - MMQA supports the development and implementation of quality assurance measurements and audits, and assists in improving medical management processes throughout the enterprise through coordinating and engaging in activities to resolve deficiencies. The Quality Improvement Specialist â€" MMQA monitors, performs, or manages quality assurance processes including those supporting compliance to regulatory and/or accreditation standards. Position will! collect, analyze and report on a variety of data to assess the quality and appropriateness of care and treatment of members and to provide oversight in the allocation and utilization of program resources.

Responsibilities:

• Develops and implements metrics and performance targets that assess compliance with CMS regulations and best practices in medical management.
• Oversees/performs audits of medical management staff for compliance with health plan policies and procedures and with regulatory and accreditation requirements.
• Assures that quality assurance audits are completed in a timely fashion and are reported back to the audited entity within the required time parameters.
• Utilizes quality assurance and quality improvement evaluation methodologies for measurement of protocol compliance and to sustain survey readiness, including ongoing internal competency/preparedness reviews.
• Analyzes data to determine trends a! nd resource utilization for use in optimizing compliance and to prepare! reports describing individual performance.
• Coordinates improvement activities for successful accrediting, licensing, and certification surveys (e.g., Joint Commission, Dept of Health, Centers for Medicare/Medicaid Services).
• Identifies to the health plan through the analysis process a summary of issues and/or policies that have the potential to negatively impact clinical outcomes and/or the delivery of quality healthcare.
• Assists in the education of providers in the importance of following the documentation guidelines that have been established in accordance with state, Federal regulatory and accreditation requirements.
• Collaborates in the implementation, monitoring and reassessment of quality improvement plans
• Maintains working knowledge of CMS and HIPAA regulations standards as pertinent to the Health Plan.
• Works with Medical Management staff and provider partners to develop appropriate action plans to improve quality! of health care delivery.
• Maintains the goals and objectives of the Quality Improvement Program, Quality Management Work Plan and the Company’s strategic initiative.
• Monitors cases in database to identify trends, emerging issues, and presents to quality committees.
• Conducts focused examination of conditions requiring correction, and develop a precise definition of the problem.
• Coordinates with providers to communicate and ensure adherence to healthcare quality management guidelines.
• Maintains all documentation related to delegation oversight including schedules and calendars for oversight activities, and electronic and paper documentation of audits performed.
• Develops a delegation oversight team including appropriately qualified auditors across the enterprise to perform pre-operational and annual audits for specified delegated functions.
• Educates and trains audit team members to procedures, tools, and regulato! ry/compliance requirements.
• Leads the Quality Improvement Comm! ittee(s) for expansion markets in new and existing health plans including establishing membership, schedules for meetings, agenda’s, and educating membership regarding collecting and analyzing reporting metrics.
• Perform and/or oversee Quality Assurance audits for the Medical Management/Health Services business units that includes, but is not limited to: interrater reliability evaluation, Chapter 13 compliance, care management activities, productivity, and other elements as determined by the Chief Medical Officer, Medical Directors, and executive leadership.
• Utilizes standardized evaluation tools for audits and provide reports to business owners and to the Quality Improvement Committee(s) of audit results.
• Assists in the development of improvement plans with department/unit managers and supervisors in response to identified deficiencies.
• Maintains documentation related to oversight including schedules/calendars of audits and monitoring a! ctivities, and electronic and/or paper copies of audits and follow-up activities.
• Establishes/maintains a collegial relationship with business owners and department leaders to promote a cooperative and constructive environment for improvement.
• And all other duties assigned by manager or supervisor.

Required Skills: •Excellent written and verbal communication skills

• Strong data entry skills with the ability to pay close attention to detail
• Must have a track record of producing work that is highly accurate, demonstrates attention to detail, and reflects well on the organization

Qualifications:

• Bachelor’s degree in a clinical field
• Registered Nurse with current licensure in Texas and eligibility to be licensed in other states as needed
• Experience in health plan operations or health plan quality improvement (Ideally, candidate will have worked in Medicare Advantage hea! lth plans)
• Experience in performing oversight activities or qu! ality assurance will be advantageous
• Computer experience should include Microsoft Word, Excel, PowerPoint and Outlook at the intermediate level at a minimum

Universal American Corp. is an Equal Opportunity / Affirmative Action Employer and does not discriminate because of age, color, disability, ethnicity, marital or family status, national origin, race, religion, sex, sexual orientation, military veteran status, or any other characteristic protected by law. We are committed to attracting, retaining and maximizing the performance of a diverse and inclusive workforce.
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If you were eligible to this position, please email us your resume, with salary requirements and a resume to APS Healthcare.

If you interested on this position just click on the Apply button, you will be redirected to the official website

This position starts available on: Wed, 27 Nov 2013 07:11:16 GMT

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