Houston, United States
8 months ago
- Manager is looking for candidates in EITHER of the below locations. This will be an in-office position that will be based in either:
2800 North Loop West Houston, TX 77092 OR 500 Great Circle Road Nashville, TN 37228
Position is responsible for conducting the functions of Quality Management in a timely, efficient manner and ensuring achievement of QM objectives. Specific responsibilities include, but are not limited to:
Reviews potential quality of care (QOC) cases including medical record reviews.
Prepares summary of findings, assigns level to case, and prepares resolution letter to customer.
Prepares and sends corrective action plans in collaboration with Medical Directors.
Prepares case studies for presentation to Physician Advisory Committee (PAC).
Assists with preparation of and may present quarterly PQOC reports to Corporate Quality Improvement Committee (CQIC) and PAC.
Defines and documents policies, procedures and processes related to QOC.
Interacts with Grievance Administration Division on identification and resolution of issues related to QOC complaints.
Identifies actions required to improve performance and work with regional and national teams to improve results.
May assist in the preparation, management and presentation of other Quality activities and reports including submission of all compliance related documentation.
Creates and maintains quality management files.