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[QA/QC Manager] Quality Assurance Advisor

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Posted by: RCS Corporation <kjennings@rcs.jobs> on March 31, 2019 at 00:04:01. Click here to reply to this post via Email.Click here for help with email link

Post Number: 518480
Posted By: RCS Corporation
Posted On: 2019-03-31 00:04:01
Email Address: kjennings@rcs.jobs
Subject: [QA/QC Manager] Quality Assurance Advisor
Contract / Temp to Direct / Direct Hire: Contract
City: Atlanta/Cincinnati/Washington DC
Country: United States
Reply to Recruiter via Text Msg: 7049405920

RCS Corporation has an immediate need for a Quality Assurance Advisor located at any of the client's research laboratories and offices in Washington, DC, Cincinnati, OH, or Atlanta, GA. Occasional travel will be required to meet with stakeholders and partners in New York City, NY. Travel will be reimbursed per Federal Travel Regulations.

Job Summary:
The Quality Assurance Advisor will help support the World Trade Center Health Program (WTCHP). The Advisor will provide services focused on supporting the management and oversight aspects of reauthorization of the James Zadroga 9/11 Health and Compensation Act of 2010. On December 18, 2015, President Obama signed the James Zadroga 9/11 Health and Compensation Reauthorization Act which reauthorized the World Trade Center Health Program (WTCHP) for 75 years, ending in 2090.

Scope of Work
Develop and implement quality assurance activities for all aspects of the WTCHP that include enrolling members, approving health conditions, establishing coverage limits, adhering to medical policies and protocols, using resources effectively, safeguarding personal identifying information and protected health information and preventing fraud, waste and abuse.
Evaluate data related to enrollment of members, certification (approval) of health conditions, health care utilization and costs of health care.
Identify and apply benchmarks of performance for medical and pharmacy benefits based on best practices in the field of health care that have similarities to the WTCHP.
Develop dashboards of key performance indicators on the status of critical aspects of the WTCHP and make recommendations to address any areas of deficiency.
Evaluate audit practices to ensure that appropriate areas are included, required information is utilized, analyses are done correctly, findings are interpreted properly, and disseminated appropriately, and remedial actions are defined and implemented.
Review health care payment decisions with respect to WTCHP policies and procedures, including analyses of denials and appeals by providers or members, to determine adequacy of the information used to make decisions and consistency of the decisions.
Reporting – develop and implement practices to distribute, archive and store QA reports and QA methodology; optimize ways to visualize QA metrics; identify and implement effective and efficient approaches to synthesize and condense large amounts of information and data.

Minimum Requirements
PhD plus 10 years experience; MS plus 12 years experience; BS plus 15 years experience (PhD or MS preferred) in related field (Quality Assurance).
Experience working in a health care environment.
A working knowledge of audit practices.
Proven ability to work in scope of work areas.
Excellent written and oral communications skills.
Knowledge of computer software such as Microsoft Word and Excel.
Demonstrated exceptional planning and organizing skills.
Ability to work independently and in collaboration with a professional group.
Ability to pass and maintain a local NIOSH Security Clearance.
Ability to pass a drug screen.
The Consultant shall work independently and in collaboration with the Quality Assurance Team’s staff to complete the work.
Opportunities with RCS change daily. For a complete listing of our current openings, please visit our website at www.rcs.jobs.

RCS is an Equal Opportunity Employer. RCS provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.


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