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Investigations Supervisor

3 months ago

Phoenix, United States Arion Care Solutions Full time
Job DescriptionJob Description

*** Must live in the Greater Phoenix Metro area ***


PURPOSE: The Investigations Supervisor coordinates and completes a variety of operational tasks to ensure delivery of quality services in a safe environment. The Investigations Supervisor also coordinates and ensures areas of compliance for all regulatory standards.


MINIMUM QUALIFICATIONS:

  • Bachelor's degree or equivalent experience
  • Minimum 1-3 years relevant work experience, preferably in a Human Services or Quality Assurance field
  • Satisfactory background check
  • Ability to obtain DPS fingerprint clearance card
  • Bilingual (Spanish/English), preferred

COMPETENCIES:

  • Excellent oral, written and interpersonal communication
  • Excellent managerial skills
  • Excellent decision-making and time management skills
  • Excellent ability to problem solve
  • Meticulous attention to detail
  • Build, cultivate and maintain internal and external relationships
  • Strong ethics and reliability
  • Strong organizational skills with goals-driven approach and timely follow-up skills
  • Strong decision-making skills
  • Approachable and professional demeanor, and open-mindedness to feedback by fostering teamwork within all departments and team
  • Demonstrates integrity, strives for excellence and has experience supervising others
  • Excellent ability to manage and adapt to influx and change of priorities
  • Ability to work with data base and software applications, including Microsoft Office
  • Strong critical thinking skills and ability to generalize solutions
  • Ability to trouble shoot efficiently and effectively
  • A proven ability to identify and effectively resolve quality issues

ESSENTIAL JOB FUNCTIONS:

  • Knowledgeable of funding source requirements regarding incident reporting and investigations.
  • Conduct investigations related to Member, Staff and Vendor Grievances, Fact finding requests, Internal and External investigations
  • Develop and implement training of incident reporting and investigations
  • Support department with Fraud Investigations, HIPAA investigations including but limited to gathering documentation, reviewing documentation, and sending necessary documentation.
  • Provide monthly reports to include summaries and recommendations
    • Identify, track and analyze trends
  • Develop and implement compliance policies and procedures to ensure compliance with regulatory and licensing agency standards including but not limited to:
    • Incident Reports
    • Internal Fact Findings
    • Division of Developmental Disabilities (DDD) requests
    • Health Plan requests
    • Managed Care Organizations (MCO) requests
    • Corrective Action Plans (CAPs)
    • Office of Inspector General (OIG) requests
    • Arizona Health Care Cost Containment Systems (AHCCCS) and other funding source and regulatory requests
  • Conduct in-person Quality Assurance visits, as necessary
  • Other duties as assigned

PHYSICAL AND MENTAL REQUIREMENTS:

  • The ability to lift items up to 50 lbs., including boxes of paper.
  • The ability to walk, kneel, stand, and bend.
  • Must be able to sit and work at a computer for extended periods of time.
  • Ability to use and work with computer software and databases to track information, good familiarity with Microsoft Outlook, Word and Excel.
  • ­Ability to exercise patience and use good judgment while working quickly.

EQUIPMENT NORMALLY USED:

  • Computer
  • Internet
  • Multi-functional printer/scanner
  • Cell Phone
  • May require the use of vehicle

WORK ENVIRONMENT:

This job operates as a remote tele-work position, as Arion Care Solutions does not provide a separate workplace at a corporate location. Working from home requires a high degree of discipline and the ability to have a space dedicated to work in the home and provision for childcare if appropriate. This position may require travel to different locations and in-person meetings.