Title: Quality Improvement Coordinator I
Location: Remote NV
Duration: 90 Days | Possible extension/conversion
Schedule: Schedule: Training Mon-Fri 8am-5pm 4 weeks training classroom & 1on1 virtual CAMERAS ON NO TIME OFF during training
Working shift Mon-Fri 8am-5pm
PR: $25-27.50/hr
Responsibilities:
- Conduct review of delegated entities for compliance with quality, service performance and utilization, credentialing reviews and medical record audits.
- Perform community activities related to clinical initiatives such as health fairs and communication with agencies and providers.
- Collaborative culture. Key project to complete AHCCCS Medicaid QOC investigations.
- Systems Word, teams, outlook, power point, excel, one drive, one note & specialized report system.
- Receive 1-3 QOC investigations daily that are due 60 days from the assignment date.
- Reviewing medical records, provider policies/manuals and statutes to ensure providers are rendering appropriate care to our members per the guidelines.
- Writing an investigative report of findings and submitting reports.
- Expectation to complete 1 investigative report per day.
- The role is unique as it requires clinical knowledge to be able to identify quality concerns and develop quality improvement plan to address the concerns with the provider.
Years of experience required:
- 3+ years of clinical, quality improvement or healthcare experience.
- MUST have BH or physical health setting experience.
- 2+ years of experience in quality function in a healthcare setting.
Disqualifiers: No clinical BH or physical health experience
Preferred:
- Bachelor's degree in nursing or license counselor/ SW preferred.