RN Quality Program Manager

Company: CareNational Healthcare Services
Location: Chandler
Posted on: April 8, 2021

Job Description:

Quality Program Manager
Chandler, AZ (Phoenix East Valley)
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*** Full-Time Opportunity that offers FREE Health Insurance--& excellent PTO - includes birthday off with pay! ***
* Can Start Remotely due to COVID-19 (after 1 week of training)! *

Quality Program Manager Job Summary:
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• Responsible for member and provider experience survey completion and submission to both quality and utilization committees, and primary contact for questions from vendor.
• Oversight of Appeals & Grievances process ensuring cases, including PQI issues, are handled appropriately according to health plan delegation agreement and within specified time frames.
• Monitoring, reporting, and summarization of QI Program activities for presentation to QIC including ensuring compliance with regulatory reporting requirements.
• Responsible for oversight of the Quality process per health plan requirements.
• Oversee the processing of providers and HDO's, including supervision of staff gathering information and primary source data required to complete credentialing/re-credentialing cycles.
• Function as primary credentials contact and oversee preparation and coordination of credentialing audits in compliance with delegation agreements, State and Federal standards and NCQA standards.
• Coordinate annual compliance training to ensure all employees understand and adhere to CMS guidelines outlined within Compliance Plan.
• Monitor compliance activities of all departments and identifies potential areas of risk.
• Responsible for conducting annual audit of FDR's to ensure completion of compliance related CMS and health plan requirements.--
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  Quality Program Manager Background:
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  • Active, current, and unrestricted state Registered Nurse (R.N.) license--
  • Requires Bachelor's Degree in Nursing;--Master's degree in business, healthcare administration, or related field--is a plus
  • 3-5 years of experience in healthcare quality including NCQA Accreditation
  • Strong understanding of attaining National Committee for Quality Assurance (NCQA) accreditation.
  • Strong oral and written communication skills; ability to interact with all levels of internal and external contacts.--
    #CLINICAL

Keywords: CareNational Healthcare Services, Chandler , RN Quality Program Manager, Executive , Chandler, Arizona