Support Staff Quality Review Specialist

Overview

Support Staff Quality Review Specialist (QRS) is responsible to complete ongoing audits of Support Staff, analyze collected audit data, identify trends for staff re-training and implement corrective action plans in collaboration with Coordinated Care management. Support Staff Quality Review Specialist (QRS) is responsible for quality assurance, accuracy and overall integrity of the care management records and documentation completed by Support staff. This role is to ensure compliance with NYS DOH and CMS regulations through development of auditing tools and data validation. Provide support to Directors, Managers and Supervisors to ensure that all documentation and reporting requirements are prepared and maintained in a professional and well-coordinated manner. Support Staff Quality Review Specialist is responsible to assist with new employee orientation, training and education of Support staff within the Coordinated Care team 

The MJHS Difference

At MJHS, we are more than a workplace; we are a supportive community committed to excellence, respect, and providing high-quality, personalized health care services. We foster collaboration, celebrate achievements, and promote fairness for all. Our contributions are recognized with comprehensive compensation and benefits, career development, and the opportunity for a healthy work-life balance, advancement within our organization and the fulfillment of having a lasting impact on the communities we serve.

Benefits include:

• Tuition Reimbursement for all full and part-time staff
• Generous paid time off, including your birthday!
• Affordable and comprehensive medical, dental and vision coverage for employee and family members
• Two retirement plans! 403(b) AND Employer Paid Pension
• Flexible spending
• And MORE!

MJHS companies are qualified employers under the Federal Government’s Paid Student Loan Forgiveness Program (PSLF)

Responsibilities

• Conducts focused reviews of established workflow protocols for Support staff by using department specific audit tools, identifies trends and provides additional education as needed. Analyzes combined collected audit data and reports findings to Coordinated Care management monthly.
• Audits members’ records for quality of telephonic care management/coordination conducted by Support Staff and reviews justification for services utilizing the audit tool.
• Listens to the calls for Quality assurance made by the Support Staff to ensure consumer satisfaction as well as knowledge gaps.
• Completes focus audits/ quality calls to HF/EP members to assess for satisfaction/customer service excellence.
• Maintains statistical and graphical audit reports, and analyses reports as requested by management team.
• Participates in developing educational modules for staff orientation and re-training

Qualifications

• Baccalaureate Degree preferred
• 2 to 3 years’ experience in a managed care support role
• Minimum of two (2) years of working in care management experience required.

Min

USD $68,838.31/Yr.

Max

USD $82,605.97/Yr.