Job description

Healthcare Quality Management Specialist (Remote)

Overview:

Are you interested in empowering and sustaining positive and measurable differences in the health of individuals? Does the thought of joining a team of exceptionally talented quality specialists inspire you? Do you enjoy using your excellent analytical and writing skills to ensure client requirements are met by the consistent, reliable execution of work? Do you thrive in performing audits to ensure performance metrics are met and high-quality care is sustained? We believe in helping those with work-sustained illnesses and injuries to live their best life by providing case management and support to workers, providers, employers, and claims staff.

As a Quality Management (QM) Specialist, you are responsible for supporting the Quality Management System and the activities of the Quality Improvement committees. This involves all aspects of the Quality Management System to ensure compliance with the QMS which include, but are not limited to identifying client requirements and creating processes to ensure client requirements are met via consistent, reliable execution of work; coordinating Document Management System; performing audits to ensure performance metrics are met; tracking actual or potential areas of risk and continual improvement through mitigation of risk and mitigation of underperforming processes, and ensuring the company maintains ISO 9001:2015 Quality Management System Certification. The Quality Management Specialist will also be responsible for supporting account managers and the analytics team in preparing the annual contractually required quality assurance reports.

Quality Management Specialist Responsibilities:

• Facilitates Executive Quality Steering Committee (EQSC) and the Continuous Quality Improvement (CQI) committee meetings through agenda creation, meeting planning, minutes, and tracking.
• Serves as a knowledge expert for EQSC and CQI activities.
• Provides input to managers and teams regarding analysis, updates, and recommendations for modifications for procedures and processes to continually improve operations and protocols.
• Assist with the collection and summary of data in collaboration with Quality Committees, identifies opportunities for improvement, and present findings.
• Understands each contract's clinical quality assurance requirements and monitors compliance, in collaboration with the analytics and management teams.
• Monitors and analyzes clinical outcomes in relation to goals and contractual requirements, in collaboration with the analytics and management team.
• Performs standard and ad hoc audits of case management activities, as directed by quality committees.
• Provides feedback and coordination of improvement of quality tools, such as audit checklists and instructions.
• Assists in the identification of program deficits and coordinates team training and monitoring of corrective actions.
• Deploys and oversees performance improvement activities.
• Tracks client complaints and issues to resolution, in collaboration with the Account Managers.
• Assumes responsibility for related duties as required or assigned.

Quality Management Qualifications:

• Bachelor's or Master's Degree preferred in Healthcare, Nursing, Health Administration, or a related field
• Registered Nurse, licensed in any state, with national certification in a relevant field
• At least 10 years of experience as a nurse.
• At least 3 years of experience with Quality Management including project management, quality improvement, corrective action, auditing, and/or staff education.
• Nationally recognized Quality-related professional certification such as Certified Professional Healthcare Quality or Six Sigma (preferred).
• Experience with quality-related certification/accreditation such as ISO 9001-2015 Quality Management System or URAC.
• Experience in Workers' Compensation, Disability Management, or related industrial health environment (preferred).
• Experience with government regulations, particularly FECA experience (preferred).
• United States Citizenship
• Upon hire, federal security clearance will be required. Federal clearance coordinated by the company
• Ability to pass a preliminary credit and background check

In addition to a competitive salary, comprehensive health and welfare benefits, tuition reimbursement, and incentive compensation, confidential company offers participation and vesting in a 401(k) plan with a company match. If you would like to contribute to our important mission and work collegially in a professional organization that values intelligence, integrity, and initiative.

The information provided above has been designed to indicate the general nature and level of work of the position. It is not a comprehensive inventory of all duties, responsibilities, and qualifications required.

Important Information

Successful candidates will be required to undergo a financial and criminal background check and obtain and maintain confidential-level security clearance upon hire. We participate in the United States Federal Government E-Verify program to confirm the employment authorization of the employee upon hire.

Equal Opportunity and Affirmative Action Employer

All qualified applicants will receive consideration for employment without regard to age, citizenship status, color, disability, marital status, national origin, race, religion, sex, sexual orientation, gender identity, veteran status, or any other classification protected by federal state or local laws as appropriate, or upon the protected status of the person’s relatives, friends or associates.

Job Type: Full-time

Pay: $60,000.00 - $70,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Paid time off
• Tuition reimbursement
• Vision insurance

Schedule:

• 8 hour shift

Education:

• Bachelor's (Preferred)

Experience:

• Nursing: 8 years (Preferred)
• Quality management: 3 years (Preferred)

License/Certification:

• RN License (Preferred)

Work Location: Remote

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