Quality and Utilization Management Specialist - Compliance Specialist
Premier Healthcare Solutions
What you will be doing:
The Quality and Utilization Management Specialist will be the owner of, and the primary individual responsible for interdepartmental coordination of monitoring and preparing submissions for initial and renewal of Utilization Review (UR) state licenses. This role will work closely with legal and other industry resources to conduct regulatory research for licensing and compliance and working collaboratively with internal/external stakeholders to communicate current and relevant information and requirements.
This position will also support the Sr. Director, Quality and Utilization Management in developing, implementing, monitoring and updating quality improvement and utilization management initiatives as well as policies, procedures and processes. Provides support for URAC and NCQA accreditation program standards and surveys, as well as any other accreditation program as adopted by the company. This role will require to stay apprised of regulatory changes, guidance, and industry developments relating to compliance, quality, and utilization management.
Key Responsibilities
Documenting and tracking of all licensing requirements and application statuses.
Work with internal departments and outside vendor(s), as applicable, for the timely completion and submission of licensing requirements.
Coordinate with legal to monitor all state licensing requirements and implement changes as identified.
Provide support in developing, implementing, monitoring and updating quality improvement and utilization management initiatives.
Assist with implementing and maintaining RBUM policies, procedures and processes.
Support quality improvement initiatives, including but not limited to: monitoring, auditing, and tracking of Utilization Management Program.
Coordinate with other departments and assist as needed in performing/monitoring required UM internal audits.
Collaborating with management to develop quality assurance plans, working with employees to implement the strategies, and reviewing documents for accuracy.
Participates with URAC and NCQA accreditation program standards and surveys, as well as any other accreditation program as adopted by the company.
Assist with client audits and routine compliance tasks.
Other responsibilities as assigned by Stanson management
Required Qualifications
Work Experience:
Years of Applicable Experience - 2 or more yearsEducation:
High School Diploma or GED (Required)
Preferred Qualifications
Skills:
Demonstrated ability to assume responsibility for daily activities and projects without direct supervision, including working within time frames to meet deadlines.
Demonstrated experience with written communications and document preparation.
Demonstrated organizational skills with strong attention to detail and quality.
Experience:
Experience with policy review, report development/gathering to support NCQA/URAC accreditations.
Experience in organization, tracking, and trending of information
Experience with Utilization Management Licenses (Nationwide)
Experience with internal auditing
Education:
Associate’s degree or equivalent experience in compliance
Location:
Preferred location is east coast
Required Certifications/Licensing
CHC, preferred
Additional Job Requirements:
Remain in a stationary position for prolonged periods of time
Be adaptive and change priorities quickly; meet deadlines
Attention to detail
Operate computer programs and software
Ability to communicate effectively with audiences in person and in electronic formats.
Day-to-day contact with others (co-workers and/or the public)
Making independent decisions
Ability to work in a collaborative business environment in close quarters with peers and varying interruptions
Employees also receive access to the following benefits:
· Health, dental, vision, life and disability insurance
· 401k retirement program
· Paid time off
· Participation in Premier’s employee incentive plans
· Tuition reimbursement and professional development opportunities
Premier at a glance:
- Ranked #1 on Charlotte’s Healthiest Employers list for 2019, 2020 and 2022, and 49th Healthiest Employer in America (2022)
- Named one of the World’s Most Ethical Companies® by Ethisphere® Institute for the 13th year in a row
- The only company to be recognized by KLAS twice for Overall Healthcare Management Consulting
Employees receive:
- Perks and discounts
- Access to on-site and online exercise classes
- Paid time off to volunteer in their communities
Premier is looking for smart, agile individuals like you to help us transform the healthcare industry. Here you will find critical thinkers who have the freedom to make an impact. Colleagues who share your thirst to learn more and do things better. Teammates committed to improving the health of a nation. See why incredible challenges require incredible people.
Premier is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to unlawful discrimination because of their age, race, color, religion, national origin, ancestry, citizenship status, sex, sexual orientation, gender identity, gender expression, marital status, familial status, pregnancy status, genetic information, status as a victim of domestic violence, covered military or protected veteran status (e.g., status as a Vietnam Era veteran, disabled veteran, special disabled veteran, Armed Forces Serviced Medal veteran, recently separated veteran, or other protected veteran) disability, or any other applicable federal, state or local protected class, trait or status or that of persons with whom an applicant associates. We also consider qualified applicants with criminal histories, consistent with applicable federal, state and local law. In addition, as a federal contractor, Premier complies with government regulations, including affirmative action responsibilities, where they apply.
Premier also provides reasonable accommodations to qualified individuals with a disability or those who have a sincerely held religious belief. If you need assistance in the application process, please reply to diversity_and_accommodations@premierinc.com or contact Premier Recruiting at 704.816.5200.
Information collected and processed as part of any job application you choose to submit to Premier is subject to Premier’s .