Quality and Compliance Auditor - Webster, United States - CDS Life Transitions

Description

Summary:

The Quality and Compliance auditor coordinates and evaluates activities aimed at maintaining regulatory and contractual compliance and improving quality of service in the domains of clinical care, member/provider satisfaction, and plan operations, including development of policy and procedures.

Essential Job Functions:

+ Coordinates the development and maintains a quality management plan to address monitoring of compliance and quality metrics for delegated and non-delegated functions.

+ Develops and maintains audit and measurement tools to facilitate the collection of quantitative and qualitative data.

+ Conducts internal audits of delegated and non-delegated functions.

+ Facilitates external audits of delegated and non-delegated functions as appropriate.

+ Develops, maintains, and distributes reports on quality to include audit findings and analysis of trends, patterns, and potential quality improvement opportunities.

+ Develops and maintains policies and procedures related to quality operations for staff of iCircle Services.

+ Print, scan, process, mail, email, fax, file, etc. all relevant paperwork associated with job tasks assigned such as but not limited to: notices, contracts, letters, member communications, provider communications, etc. including coverage of tasks outside of assigned department

+ Updates member materials to ensure compliance regulatory, contract and policy compliance with NYS DOH.

+ Participates on quality committees and sub-committees as assigned.

+ Participates in the development of training programs and materials to facilitate the education of internal (non-delegate) staff on quality and compliance topics.

+ Stays abreast of industry best practices in quality and incorporates them into plans and reports.

+ Stays abreast of realized or proposed changes in the industry and proactively plans for corresponding changes to quality plans and audits.

Knowledge, Skills, and Abilities:

+ Self-motivated, flexible and positive in a fast-paced business environment

+ Efficient time management and communication

+ Interpersonal and team skills for working with employees at all levels within the company

+ Able to maintain a high level of confidentiality

+ Familiarity with quality assurance tools and software

+ Effective computer skills using MS Office products

+ Demonstrated ability to collect, manage, manipulate, and analyze data then communicate findings via meaningful reports

+ Able to accept and interpret direction competently and professionally

+ Able to perform tasks independently and as part of a team to accomplish goals.

+ Effectively manage priorities and dynamic deadlines

Education and Experience:

+ Bachelors Degree in healthcare related field (nursing, social work, healthcare administration, health informatics) preferred.

+ At least 3 years of experience within quality assurance or quality audit, writing policy and procedures, preferred.

+ Previous managed care organization experience preferred, to include familiarity with operations and regulatory requirements

+ Must be at least 18 years of age.

+ Maintain all required certifications/training by DOH, CMS, State regulations and iCircle policy.

The listed salary range represents the organization's good faith and reasonable estimate of the range of possible compensation at the time of posting. The offered salary will be determined by: Applicant qualifications and experience, education, position specific licensing/training and departmental budgets.

CDS Life Transitions is an Equal Opportunity Employer, and as such affirms the right of every person to participate in all aspects of employment without regard to gender, race, color, religion, national origin, ancestry, age, marital status, sexual orientation, pregnancy, disability, citizenship, military or veteran status, gender expression and/or identity, or any other status or characteristic protected by federal, state, or local law. CDS Life Transitions will make reasonable accommodations for known physical or mental limitations of otherwise qualified employees and applicants with disabilities unless the accommodation would impose an undue hardship on the operation of our business. If you are interested in applying for an employment opportunity and feel you need a reasonable accommodation pursuant to the ADA, please contact us at