Quality Management Auditor
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Job Location:
Philadelphia, PA - USA
Monthly Salary:
Not Disclosed
Posted on:
Yesterday
Vacancies:
1 Vacancy
Job Summary
Job Details
Working under minimal supervision schedule and conduct practitioner site audits for compliance with medical record preventive care access and availability and practice site standards for the purpose of credentialing and re-credentialing practitioners and ongoing monitoringJob Description
Summary
Working under minimal supervision schedule and conduct practitioner site audits for compliance with medical record preventive care access and availability and practice site standards for the purpose of credentialing and re-credentialing practitioners and ongoing monitoring
Job Duties
- Schedule and conduct practitioner site audits for compliance with medical record preventive care and practice site standards.
- Coordinate access and availability monitoring in conjunction with network management and the external vendor to ensure members access to care
- Complete assignments to ensure providers have a valid audit every two years.
- Communicate results (including failed audits and required CAPs) to the appropriate departments/individuals within established timeframes.
- Ensure CAP audits are scheduled and completed within required timeframes.
- Review audit results with practitioners and site staff at exit interview. Serve as resource to practitioner and staff for areas identified as needing improvement.
- Yearly review and update of changes for preventive care guidelines
- Review audit findings with Medical Director for corrective action as warranted and according to policy and procedure.
- Prepare documentation with QM 1 coordinator of case review for peer review activities and the Quality Management Committee.
- Update databases and spreadsheets with audit findings. Maintain accuracy and timeliness in database management.
- Collaborate with Provider Relations and Credentialing Department staff for timely completion of audits and provider profiles for re-credentialing purposes
Minimum Qualifications
- Specialized Diploma Graduate of accredited school of nursing RN
- 2 years experience in quality management monitoring activities and/or credentialing/ recredentialing reviews.
- Development implementation and evaluation of quality management activities in acute and/or ambulatory health care settings.
- Excellent verbal and written communication skills.
- Ability to present and discuss clinical quality of care issues with Management and Medical Director.
- Strong analytical and problem solving skills.
- Strong organizational skills and ability to manage multiple priorities.
- Ability to function independently with minimal supervision.
- Valid drivers license and insurance.
- Ability to travel (to and from office sites) at least 70% of the time.
- Moderate walking required.
- Lift/push/pull/hold/carry up to 10 pounds.
- Basic understanding of QM principles.
- Basic computer skills in Outlook MS Word Excel and Access.
- RN - Licensed Registered NursePA - State of Pennsylvania
Preferred Qualifications
- Knowledge of NCQA standards preferred.
- Familiar with Philadelphia and surrounding areas preferred.
- Basic computer skills in Outlook MS Word Excel and Access preferred.
Physical Demands
Lift and carry 25 lbs. frequent sitting/standing frequent keyboard use *patient care providers may be required to perform activities specific to their role including kneeling bending squatting and performing CPR.
Job Description Disclaimer: This position description provides the major duties/responsibilities requirements and working conditions for the position. It is intended to be an accurate reflection of the current position however management reserves the right to revise or change as necessary to meet organizational needs. Other responsibilities may be assigned when circumstances require.
Work Shift
Workday Day (United States of America)Worker Sub Type
RegularEmployee Entity
Health Partners Plans Inc.Primary Location Address
1101 Market Philadelphia Pennsylvania United States of AmericaNationally ranked Jefferson which is principally located in the greater Philadelphia region Lehigh Valley and Northeastern Pennsylvania and southern New Jersey is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65000 people strong dedicated to providing the highest-quality compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrows professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic clinical and applied research. Thomas Jefferson University home of Sidney Kimmel Medical College Jefferson College of Nursing and the Kanbar College of Design Engineering and Commerce dates back to 1824 and today comprises 10 colleges and three schools offering 200 undergraduate and graduate programs to more than 8300 students. Jefferson Health nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.
Jefferson is committed to providing equal educational and employment opportunities for all persons without regard to age race color religion creed sexual orientation gender gender identity marital status pregnancy national origin ancestry citizenship military status veteran status handicap or disability or any other protected group or status.
Benefits
Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues including medical (including prescription) supplemental insurance dental vision life and AD&D insurance short- and long-term disability flexible spending accounts retirement plans tuition assistance as well as voluntary benefits which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues including those who work less than part-time(including per diemcolleagues adjunct faculty and Jeff Temps) have access to medical (including prescription) insurance.
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Required Experience:
IC
Key Skills
About Company
At Thomas Jefferson University in Philadelphia, PA, we are helping you to redefine what’s possible with innovative and tailored education opportunities.
