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Quality Control Manager
3 days ago
H & H Consulting San Antonio, United StatesOverview: · - Develops, implements, and maintains a comprehensive quality management system to ensure compliance with industry standards and regulatory requirements. · - Oversee all aspects of the cement quality control production process, including testing procedures, data analy ...
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ZephyrTech San Antonio, United States"At the heart of life" the DOMICIL Group provides care for our residents at over 45 locations with more than 5,500 dedicated colleagues. We are a family-owned company and believe that trust is built through actions, not promises. That's why we have rules that value each individua ...
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Quality Manager
2 weeks ago
Satterfield & Pontikes San Antonio, United States· Due to growth and expansion we are adding a Quality Manager to oversee our Central TX region. We have projects in both the Austin and San Antonio area. In this position you will report to our Corporate Quality Manager and working very closely with the local VP. · On top of a ...
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Quality Manager
3 weeks ago
Lumicity San Antonio, United StatesOur client is a privately owned manufacturing firm in San Antonio that manufactures high end products, they are Looking for a seasoned Quality Manager. Drive quality control efforts, oversee inspections, and maintain excellence in manufacturing while leading a dedicated team. · R ...
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Manager, Quality Management
3 weeks ago
University Health San Antonio, TX, United StatesPOSITION SUMMARY/RESPONSIBILITIES · Manages, supervises and assists the Director, Population Health Management (PHM) with oversight of short-term case management (CM) therapy services to facilitate high quality, cost effective care for Community First Health Plans, Inc. (Communi ...
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Quality Assurance Manager
3 weeks ago
Aegis Worldwide San Antonio, United StatesJob Title: Quality Assurance Manager · Location: Boerne, TX · Job Type: Full-time · Schedule: Monday-Thursday · About Us: Aegis Worldwide is a recruiting firm that works with clients in the manufacturing and engineering space. Our client is a leading provider of high-quality ...
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Quality Assurance Manager
2 days ago
ICF International Inc San Antonio, United StatesThe Quality Assurance Manager will be responsible for oversight of all quality assurance operations related to the ORR Call Center and execution of project deliverables. The position will in coordination with operations manager new performance strategies to ensure compliance as w ...
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Quality Assurance Manager
1 week ago
ICF San Antonio, United States Paid WorkThe Quality Assurance Manager will be responsible for oversight of all quality assurance operations related to the ORR Call Center and execution of project deliverables. The position will in coordination with operations manager new performance strategies to ensure compliance as w ...
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Construction Quality Manager
2 weeks ago
Microsoft Corporation San Antonio, United StatesMicrosoft's Cloud Operations + Innovation (CO+I) organization is the engine that powers our cloud services. Our data center construction team is dedicated to delivering the highest quality data centers for our cloud services. As we continue to revolutionize the way construction p ...
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quality assurance manager
3 weeks ago
ResCare Community Living San Antonio, United StatesOur Company: · ResCare Community Living · Overview: · The Quality Assurance Manager (QAM) position is focused on maintaining local compliance with State, Federal and BrightSpring Health requirements. The QAM provides leadership oversight to operations in meeting their goals an ...
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quality assurance manager
1 week ago
BrightSpring Health Services San Antonio, United StatesOur Company · ResCare Community Living · Overview · The Quality Assurance Manager (QAM) position is focused on maintaining local compliance with State, Federal and BrightSpring Health requirements. The QAM provides leadership oversight to operations in meeting their goals and ...
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Quality Assurance Manager
3 weeks ago
Lucifer Lighting San Antonio, United StatesJob DetailsLevelManagementJob LocationCorporate Office - San Antonio, TXPosition TypeFull TimeEducation Level4 Year DegreeJob ShiftDayDescriptionPosition Summary: The Quality Assurance Manager is responsible for setting best-in-class quality standards by maintaining consistent qu ...
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quality assurance manager
3 weeks ago
All Ways Caring HomeCare San Antonio, United States· QUALITY ASSURANCE MANAGER · Job Locations · US-TX-SAN ANTONIO · Requisition ID · Line of Business: · ResCare Community Living · Pay Min · USD $43,000.00/Yr. · Pay Max · USD $43,000.00/Yr. · Our Company · ResCare Community Living · Overview · The Quality Assurance Manager (QAM ...
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Quality Assurance Manager
1 week ago
ICF International Inc San Antonio, United StatesThe Quality Assurance Manager will be responsible for oversight of all quality assurance operations related to the ORR Call Center and execution of project deliverables. The position will in coordination with operations manager new performance strategies to ensure compliance as w ...
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Quality Assurance Manager
2 weeks ago
Lucifer Lighting San Antonio, United StatesJob Details · Level · Management · Job Location · Corporate Office - San Antonio, TX · Position Type · Full Time · Education Level · 4 Year Degree · Job Shift · Day · Description · Position Summary: · The Quality Assurance Manager is responsible for setting best-in-cl ...
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Quality Management Lead
3 weeks ago
Hyatt Vacation Ownership San Antonio, TX, United StatesAre you ready to grow your dream career while making others' vacation dreams come true? Marriott Vacations Worldwide is a world premier organization for Vacation Ownership with resorts at destinations around the globe. Join our team and help deliver unforgettable experiences that ...
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Manager, Quality Assurance
3 weeks ago
Worldwide Clinical Trials San Antonio, United StatesWho we are · We're a global, midsize CRO that pushes boundaries, innovates, and invents because the path to a cure for the world's most persistent diseases is not paved by those who play it safe. It is built by those who take pioneering, creative approaches and implement them wi ...
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Quality Assurance Manager
1 week ago
ResCare San Antonio, United StatesOur Company · ResCare Community Living · Overview · The Quality Assurance Manager (QAM) position is focused on maintaining local compliance with State, Federal and BrightSpring Health requirements. The QAM provides leadership oversight to operations in meeting their goals and ...
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RN Quality Manager
3 weeks ago
UnitedHealth Group San Antonio, United StatesOpportunities at WellMed, part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will join a team who shares your passion for helping people achieve better health. With opportunities for physicians, clinical st ...
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Quality Assurance Manager
2 days ago
ICF International Inc San Antonio, United StatesThe Quality Assurance Manager will be responsible for oversight of all quality assurance operations related to the ORR Call Center and execution of project deliverables. The position will in coordination with operations manager new performance strategies to ensure compliance as w ...
RN Quality Manager - San Antonio, United States - Optum
Description
Opportunities at WellMed , part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will join a team who shares your passion for helping people achieve better health. With opportunities for physicians, clinical staff and non-patient-facing roles, you can make a difference with us as you discover the meaning behindCaring. Connecting. Growing together.
The
Quality Manager
is responsible for driving consistency in program implementation designed to facilitate a minimum of a 4 Star quality rating.
These initiatives should result in contracted network being able to understand and support the vision to change the face of healthcare delivery for seniors.
This will drive the financial viability of the market HEDIS/Star program and provide a full quality of care for the members.
The responsibilities of this position demand a wide range of capabilities including:strategic planning and analysis skills; strong understanding of HEDIS and coding; management breadth to direct and motivate; highly developed communication skills;
and the ability to develop clear action plans and drive process, given often ambiguous issues with numerous interdependencies. This position will facilitate any unresolved issues that remain as a result from following the standard process.
Primary Responsibilities:
Manages Quality Coordinators, Clinical Quality Consultants (CQC) I, II and Senior CQC and/or support staff (Community Health Care Worker, Transition Care Navigators) is responsible for the overall success of the market's HEDIS/Star results for contracted physicians
Responsible
for
all
aspects
of
staff
development
to
include
hiring,
training,
coaching
and development
Maximizes staff performance and technical expertise through clearly defined objectives, training, skill development and leadership to ensure quality services to all customers
Delegate, monitor and control work progress on key HEDIS/Star metrics, initiatives/action plans, staff productivity, and administrative expenses
Participates in development and implementation of systems and processes that support quality operations
Maintains effective cross functional services by working effectively with the Medical Director, Market Medical Director, Market Operations, Regional Team, Clinic Operations and other corporate departments
Handles complex and/or difficult provider inquires and/or problems and facilitates resolution of provider issues. Continuously strive to ensure that favorable relationships are maintained while ensuring the interest of the organization
Takes ownership of total work process and provides constructive information to ensure physician partners have support to meet initiatives
Analyzes data while collaborating and/or participating in discussions with colleagues and business partners to identify potential root cause of issues
Demonstrate understanding of providers' goals and strategies in order to facilitate the analysis and resolution of their issues
Work with relevant internal stakeholders to identify obstacles and barriers identified by providers, and methods for removing them
Communicate and advocate providers' needs to internal stakeholders in order to drive creation of solutions that meet our HEDIS/Star goals
Communicate industry and company information to providers through various means (e.g., newsletters; emails; outreach calls; teleconference; conferences; on-site meetings)
Develops and coaches staff to facilitate strategic business meetings with physician groups and their staff
Guides, oversees and ensures competency of the Quality market staff
Assist corporate and local education team and provides input on tools used to education quality staff and other local provider support staff
Ensures all education objectives are being met, both on a formal and ad-hoc basis
Responsible for ensuring the quality staff is responding to market operation and provider inquiries
Facilitates provider discussions and assists in negotiating resolution to escalated provider issues with the capability to determine if/when issues require escalation
Collectively works with cross functional leadership to eliminate duplication of efforts and member or provider abrasion
Includes up to % local travel
Performs all other related duties as assigned
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
4+ years of related experience in Quality/HEDIS/CMS Stars, and ICD10/CPT/CPT II coding knowledge, Provider Relations
1+ years of supervisory experience
Solid working knowledge of Medicare quality operations including HEDIS, Stars, Coding and Medicare Advantage
Knowledge of state and federal laws relating to Medicare
Advanced Microsoft Office skills, proficient in Excel
Exceptional analytical and data representation expertise
Ability and willingness to travel, both locally and non-locally, as determined by business need
Preferred Qualifications:
Project Management experience
Solid knowledge base of clinical standards of care, preventative health, and STAR measures
Solid financial analytical background within Medicare Advantage plans (Risk Adjustment/STARS Calculation models)
Physical & Mental Requirements:
Ability to lift up to 10 pounds
Ability to sit for extended periods of time
Ability to stand for extended periods of time
Ability to use fine motor skills to operate office equipment and/or machinery
Ability to receive and comprehend instructions verbally and/or in writing
Ability to use logical reasoning for simple and complex problem solving
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone.
Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes.
We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
Diversity creates a healthier atmosphere:
UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.#J-18808-Ljbffr
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