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Director of Quality Improvements and Accreditation (NCQA)

Company: Max Populi, LLC
Location: Miramar
Posted on: November 18, 2021

Job Description:

Director of Quality Improvements and Accreditation (NCQA). Miramar, FL. Unique opportunity to provide quality oversight of utilization management "UM" functions in compliance with a rapidly growing integrated healthcare organization in Southern Florida.. Can be 100% REMOTE.. Will consider a FL Compact RN license. The ideal candidate will ensure that the UM procedures and delegation expectations are synchronized and administered with appropriate and timely quality of care and services.. Responsibilities. Facilitate continuous improvement in UM/QM and clinical operations through collaboration with other departments and contracted health plans and continuous monitoring of clinical metrics through QA activities. Ensures departmental and intra-departmental compliance standards with regulatory and accreditation agency are being met. Manage development of policies and procedures related to QA activities, reviews, and delegation oversight requirements. Manage regulatory audits, including preparation and monitoring of any corrective plans, timely collections of reporting with data analysis to meet quality and delegation requirements. Fulfill and maintain compliance with federal, state, and NCQA requirements including corrective action plan (CAP), monitoring CAP activities, and providing education and tools as needed. Collaborate with health plans, downstream provider groups, and accreditation authorities as necessary. Maintain professional and technical knowledge by attending educational workshops, reviewing professional publications, and completing all requirements for ongoing licensures and certifications. Facilitate QA-related collaborative interaction with health plans, downstream provider groups, and accreditation authorities. Monitor compliance with provider organization quality background investigation and subsequent report to Credentialing Committee. Skills. Superlative organizational, writing, and communication standards. Self-motivated with the ability to work autonomously. Working knowledge of Outlook, Excel, Word, and Adobe Acrobat Pro. Detail-oriented with the ability to work on multiple, competing, priorities and is extremely organized. Possess analytical, verbal, and written communication skills, able to interface with UM and interrelated process owners and maintain effective working relationships with others. Requirements. Bachelor's degree with a focus in healthcare administration; Master's degree (MHA) preferred. Minimum of three years of experience in a health plan/ hospital setting primarily in UM/compliance function. Some home healthcare experience preferred. Experience with Utilization Management or Quality Improvement Plans (QIP) with InterQual and/or Milliman, CMS, and peer reviewed guidelines required. Valid Registered Nurse (RN) REQUIRED. Contact information:. ________________________________________________

Keywords: Max Populi, LLC, Hollywood , Director of Quality Improvements and Accreditation (NCQA), Executive , Miramar, Florida

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