Director of Quality and Clinical Compliance
Director of Quality and Clinical Compliance
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1 Vacancy
Job Description
About Acrisure:
Acrisure is a global Fintech leader that combines the best of humans and high tech to offer multiple financial products and services to millions of businesses and individual clients. We connect clients to solutions that help them protect and grow what matters including Insurance Reinsurance Cyber Services Mortgage Origination and more.
Acrisure employs over 17000 entrepreneurial colleagues in 21 countries and have grown from $38 million to $4.3 billion in revenue in just over ten years. Our culture is defined by our entrepreneurial spirit and all that comes with it: innovation client centricity and an indomitable will to win.
Job Summary:
Providing quality service and accurate results supports our primary mission as a trusted adviser to our clients. As Director of Quality and Clinical Compliance you will be working in a fast-growing company and work environment. Your valuable role and focus will include oversight of and compliance with state regulatory rules pertaining to managed nursing services.You will also oversee quality compliance with Best Practice Standards and Customer Specific Account Instructions (SAI). As a member of the Ascential leadership team you will continue to reinforce Ascentials mission of being a market leader and collaborative partner to ACPs current and prospective Customers.
Duties:
Develop implement and maintain oversight of the Compliance activities of the Case Management and Clinical nursing management programs
Create manage and support new hire orientation and training for all roles as well as ongoing training needs
Oversee nursing licenses and renewals
Facilitate and promote training opportunities that offer valuable topics and CEU credits
Develop and maintain a system of regulatory review that includes proactive communication and collaborative initiatives and ensures continuing compliance for nurse licensure certification requirements and other pertinent requirements to perform nurse case management services
Establish create and participate in Case Management policy and procedure development and review conduct analysis and drive toward Ascentials goals
Participate as a key member in the Quality Management Committee
Oversee calibration of Case Management auditors audit tools and reporting QA/QMC reporting and all quality improvement projects (QIP)
Develop and deliver training presentations and curriculum that support clinical programs and quality improvement goals
Collect data and metrics and perform analysis of benchmarked goals and clinical quality improvement objectives
Support URAC activities as assigned to include preparation for site visits desktop audits and ongoing maintenance of certification
Participate in the team compiling state UR audit responses as requested
Provide monthly feedback to leadership on quality concerns and recommended training topics to improve case management performance
Facilitate communication and training coordination between leaders and members of the Ascential Care team
Maintain professional and industry knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies.
Maintain a cooperative relationship among teams by communicating information; responding to requests; building rapport; participating in problem-solving methods
Other duties as assigned from time to time.
Job Qualifications:
Bachelor or higher degree in Nursing Business or another related field. The degree must be from an institution that is fully accredited by a nationally recognized educational accreditation organization
Current active and unrestricted Nursing licensure or certification in a state or territory of the United States that allows the professional to conduct an assessment independently as permitted within the scope of practice of the discipline
Current active and unrestricted licensure or certification in Nursing in a state or territory of the United States
Job Requirements:
Ten full-time years in a quality and/or training role or in a role performing similar duties
Demonstrated ability to establish and maintain effective individual and team working relationships with internal and external partners clients and the ACP leadership team.
Excellent oral and written communication skills
Knowledge of medical quality improvement and nursing practices in a managed care environment
Knowledge of regulatory and accreditation agencies and requirements
Able to manage multiple priorities and deadlines in an expedient and decisive manner
Proficiency in Microsoft applications
Be hands-on adaptable focused flexible data driven results-oriented and a high performer
Proven analytical skills required
Physical Demands:
While performing the duties of this position the employee is frequently required to walk stand bend kneel stoop communicate reach and manipulate objects. Duties involve moving materials weighing up to 10 pounds on a regular basis such as files books office equipment etc. and may infrequently require moving materials weighing up to 30 pounds. Manual dexterity and coordination are required while operating equipment such as computer keyboard calculator and standard office equipment.
Home office provisions include phone voice mail PC scanner and internet access (high speed internet connection and strong cell phone network access are required).
Duties may be performed in a home-office setting with up to 20% travel required for industry conferences client meetings and internal company collaborations.
Use of the telephone and communication via electronic mail is required daily.
Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
*References: CMSA Standards of Practice URAC
Reports to: Vice President of Clinical Programs of ACP Status: Exempt
Acrisure is committed to employing a diverse workforce. All applicants will be considered foremploymentwithout attention to race color religion age sex sexual orientation gender identity national origin veteran or disability status. California residents can learn more about our privacy practices for applicants by visiting the Acrisure California Applicant Privacy Policy available at Executive Search Firms & Staffing Agencies: Acrisure does not accept unsolicited resumes from any agencies that have not signed a mutual service agreement. All unsolicited resumes will be considered Acrisures property and Acrisure will not be obligated to pay a referral fee. This includes resumes submitted directly to Hiring Managers without contacting Acrisures Human Resources Talent Department.
Required Experience:
Director
Employment Type
Full-Time
