Mgr, Quality Assurance - HPRA
Location: Lenexa Kansas
Description: Quest Diagnostics is looking of Mgr, Quality Assurance - HPRA right now, this vacancy will be placed in Kansas. More details about this vacancy opportunity kindly see the descriptions. The Journey Begins with you.
There's quite a distance between wondering and knowing. And for patients waiting for answers to important health questions, it's a road they want to travel as quickly as possible.
At Quest Diagnostics Incorporated, we understand urgency. But more than speed, we focus our energies on accuracy. Currently, we seek a Quality Assurance Manager.
Responsibilities
Job Summary
Responsible for leading and managing clinical operations for the Health Plan Risk Assessment (HPRA) department of ExamOne, while ensuring compliance with state and federal regulations and guidelines, CMS compliance and audit guidelines, and HIPAA, NCQA and HEDIS standards. The scope of these operations comprise 1) onsite member health assessment, screening, health education, and lab draws and testing services, 2) ensuring clinically accurate, comprehensive and specific CMS/RAC-compliant documentation of health and clinical indicators and diagnoses supporting HCC coding and care planning, 3) ensuring the clinical efficacy of the collection and reporting of assessment, screening, and test results assessment results and related data, 4) recruiting, credentialing, training, management of advanced nurse practitioners, and oversight of parameds as relates to the delivery of HPRA services, and 5) oversight and facilitation of the HPRA Quality Assurance program in support of the clinically efficacious, effective and compliant delivery of HPRA services.
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Job Accountabilities
Leadership
1.Lead, manage and direct HPRA clinical operations under the direction of the HPRA Medical Director, with dotted line reporting to the HPRA Business Leader. Influence may be exerted both directly and indirectly through the management of interdisciplinary teams, contractors and vendors.
2.Lead, manage and direct the recruiting, credentialing, training, and ongoing activities of providers in the administration of onsite member health screening and risk assessment. Direct providers in the appropriate diagnosis and documentation of medical conditions and health risk indicators.
3.Provide clinical oversight to the HPRA related functions of Quest parameds in the administration of mobile lab collection and biometrics screening
4.Provide oversight to the medical- and health risk-related aspects of telephonic health risk evaluation of HPRA members.
5.Represent HPRA’s clinical operations, network management and QA program to clients, prospects, providers, suppliers, vendors, to accrediting, credentialing and auditing entities, and to divisions of ExamOne/Quest Diagnostics.
Compliance
2.Ensure HPRA clinical operations, practices, policies and procedures are in compliance with CMS, DHHS, HIPAA, NCQA, JCAHO, CLIA and related state and federal regulations, audit guidelines and industry standards.
3.Monitor published guidelines for revisions to regulations and/or accreditation standards to prepare for and ensure compliance in HPRA clinical operations.
4.Ensure all providers, lab facilities and suppliers have appropriate licensure and accreditation and that personnel have appropriate qualifications, certification and/or licensure as deemed by federal, state, and local regulations.
Provider Credentialing, Training, Proficiency and Quality
5.Develop and oversee provider training program, and ongoing proficiency monitoring and corrective action, to ensure safe, compliant, effective and efficient administration of HPRA assessment, screening, lab collection, testing, diagnosis and clinical documentation by employees and providers.
6.Ensure that all HPRA employees and providers are aware of applicable regulatory requirement, industry standards and company standard operating procedures regarding CMS, DHHS, HIPAA, NCQA, HEDIS, JCAHO and CLIA as appropriate to the employees’ job duties and responsibilities.
Quality Assurance/Quality Improvement
7.Establish policies and procedures and internal infrastructure necessary to ensure the ongoing review of quality indicators relative to HPRA operations. Oversee the development of corrective action plans where needed., and reporting mechanisms necessary to ensure transparency into the HPRA QA process for purposes of internal and external audits and client due diligence.
8.Facilitate the tracking, documentation, reporting and action plans relative to the HPRA Quality Assurance (QA) activities for approval by the HPRA Medical Director.
9.Develop and monitor Quality Assurance indicators, issues, corrective actions and outcomes, for inclusion in the division-wide QA program. These include but are not limited to: Reportable Quality Issues and action plans, operational and provider proficiency, revised reports tracking, and performance on audits and inspections.
10.Ensure that any and all suppliers and delegated services maintain a comprehensive Quality Assurance program meeting HPRA, Quest, CMS, DHHS, HIPAA, NCQA, HEDIS, ACA, CLIA and other similar requirements and standards.
11.Conduct monthly QA meetings with required participation by all areas responsible for and impacting the delivery of HPRA services.
12.Prepare, revise and distribute to employees and providers a QA Manual that includes applicable HPRA, Division and Company policies and procedures. Ensure all employees are trained on the policies as appropriate to their job duties and responsbilities. Ensure all QA policies have annual review as per the QA Committee policies and procedures.
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Education
- Bachelors of Science in Nursing
- Masters of Science in Nursing (preferred)
- Masters of Science in Health Administration (preferred)
Certifications
- Certified Registered Nurse, Certified Nurse Practitioner.
- Clinical Nurse Specialist, or Clinical Nurse Leader - preferred
- AAPC Certified Professional Medical Auditor, Certified Professional Coder - preferred
Work Experience
Ten years minimum experience leading complex medical managing functions for managed care organizations, provider groups, health services organizations and/or healthcare delivery systems - to include health risk assessment, mobile laboratory, in-home care, or outpatient services.
Three to five years overseeing quality management and/or credentialing programs for managed care organizations, provider groups, healthcare services, or delivery systems
Experience supporting internal interdisciplinary teams including product development, sales and marketing, client implementation, account management, andcompliance within large and complex organizations.
Strong working knowledge of and experience developing clinical processes in compliance with CMS RAC and Compliance Requirements and Guidelines, HIPAA, DHHS, state and federal regulations, and managed Medicare/Medicaid industry best practices
Experience leading successful NCQA, CLIA, or JCAHO accreditation initiatives.
Ten years experience directly managing teams and/or networks of nurses, physicians, healthcare providers, medical technicians and/or parameds.
Three to five years in clinical practice as an CRN or CNP
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Competencies
Demonstrated ability to influence and create change--required
Strong interpersonal communication skills--required
Demonstrated strong writing and composition skills--required
Demonstrated success in motivating team members to reach objectives--required
Strong influencing skills--desirable
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Business Process Skills
Understands clinical laboratory operations--required
Able to effect Quality Improvement through problem solving skills and knowledge of quality tools--required
Able to manage change--required
Organization skills--required
Project management skills--required
Analytical skills--required
Technical skills--required
Computer skills--required
Able to function in a matrix organization--required
Multi-tasking skills--required
How To Apply
Please Log In or Register to Upload a Resume and complete the online Application. Because of the large number of applicants to job openings, Quest Diagnostics will only contact candidates to be interviewed.
Closing Statement
Quest Diagnostics has many career opportunities for individuals whose talent, initiative and dedication will complement our belief that the patient comes first and that values do matter. We work to earn our customers’ trust every day by providing the highest quality products and services in a professional, accessible and informative way. Our workforce is diverse and talented and believes in our vision: "Dedicated people improving the health of patients through unsurpassed diagnostic insights."
[All requirements are subject to possible modifications to reasonably accommodate individuals with disabilities.]
Quest Diagnostics is an Equal Opportunity Employer (EEO).
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If you were eligible to this vacancy, please email us your resume, with salary requirements and a resume to Quest Diagnostics.
If you interested on this vacancy just click on the Apply button, you will be redirected to the official website
This vacancy starts available on: Mon, 27 Aug 2012 22:10:56 GMT
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