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Post Number: 518593
Posted By: RCS Corporation
Posted On: 2019-03-31 00:04:01
Email Address: firstname.lastname@example.org
Subject: [QA/QC Manager] Quality Assurance Health Care Adviser
State: New York
Country: United States
Reply to Recruiter via Text Msg: 7049405917
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.
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 World Trade Center (WTC) Health Program that include enrolling members, approving health conditions, establishing coverage limits, adhering to medical policies, 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, 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 WTC Health Program
Develop dashboards of key performance indicators on the status of critical aspects of the WTC Health Program 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 remedial actions are defined and implemented
Review health care payment decisions with respect to WTC Health Program 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
A minimum of three (3) recent years working at health care entities (private or government) in the role of quality assurance manager that involved items such as those listed above in the job duties and that are described in the applicant's resume.
Developed or enhanced an existing comprehensive quality assurance program for a health care entity.
Lead a Quality Assurance team that produced documented improvements in delivery of health care services
Prepared or directed development of reports on quality assurance measures for all aspects of health care services that include trends, key performance indicators, interpretations of findings, and recommended actions to improve services
Prepared and made presentations to senior leadership on quality assurance activities
Experience with strategic planning, workflow analysis, business process re-engineering, problem resolution, and training and development in medical administration from an agency-level, or a strategic-level, or corporate-level operation.
Experience training/communicating/briefing at the corporate/senior leadership level
Opportunities with RCS change daily. For a complete listing of our current openings, please visit our website at www.rcs.jobs.
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