MCO Quality Coordinator

1 month ago

Cincinnati, United States CorVel Healthcare Corporation Full time
Job DescriptionJob Description

To ensure the consistent delivery of CorVel’s total workers’ compensation solution through the development, implementation and ongoing utilization of specific quality assurance tools and training leading to consistency and satisfied/loyal customers. Primary source of quality assurance and information for pharmacy solutions team. Supports management by handling quality assurance and escalated issues, monitoring representatives and completing quality assurance emails for team members. Provides informational documents such as Standard Operating Procedures, PowerPoints, emails, and departmental newsletter to assist team members in daily tasks. Provides training and team building for new hires and pharmacy representatives and supervisors. Assists team members in performing daily job duties. Acts as liaison between Pharmacy Solutions specialists, supervisors, and management team. Tracks quality assurance for individuals and the department and reports quality assurance trends.

ESSENTIAL FUNCTIONS & RESPONSIBILITIES:

  • Conduct quality reviews/audits to ensure appropriate management of the claims and office, score the office performance, and make suggestions and follow-up to ensure office has taken action on improvement recommendations
  • Identify and participate in training and developmental needs of the claims staff including the training / re-training of all offices on existing best practices and new procedures, including usages of the CorVel claim system
  • Provide back-up for incoming Pharmacy team calls by remaining in ready when call volume is high and when phone reps are in “not ready”.
  • Complete daily rejection report lines
  • Quality Assurance—gather and handle forwarded daily QA emails
  • Along with dedicated team members, complete daily Wyoming after-hours project
  • Provide back-up duties for completing outstanding emails
  • Provide supervisor and Specialist III level support to assist representatives in daily job tasks—New York workflow, compounds, California state guidelines, mail order, clinical
  • Respond to questions from specialists on a variety of issues
  • Research and handles escalated calls and e-mails in lieu of a manager
  • Assist pharmacies, adjusters, clients, claimants, and internal CorVel employees
  • Communicate changes and information as necessary
  • Assist in the training of new representatives
  • Maintain and updates reference materials, including Standard Operating Procedures
  • Provides coaching to all representatives
  • Provide team quality assurance for individuals to track monthly quality assurance
  • Provide feedback to individual team members
  • Process compounds as requested by specialists
  • Create quality assurance monthly and yearly reports for management
  • Create and keep current-comprehensive standard operating procedures for Pharmacy team use, including all department procedures, formularies, state guidelines, clinical staff, and client special considerations
  • Create and implement new-hire and ongoing professional development training documents and testing for the Pharmacy team
  • Phone Monitor reps on a rotating basis
  • Provide business-writing training for team members
  • Publish quarterly department newsletter which presents pertinent and needed information to the team
  • Complete miscellaneous pharmacy projects, as needed
  • Send anniversary emails to team, aka Terrific Tenures
  • Create and run reports, as requested
  • Additional duties as assigned

KNOWLEDGE & SKILLS:

  • Excellent professional and effective verbal and written communication skills
  • Able to identify problems and get the broad view for potential and existing quality assurance cases
  • Ability to analyze complex quality assurance situations, share findings and navigate toward an understandable solution
  • Strong knowledge and experience in quality assurance and training programs
  • Must have strong organizational skills
  • Able to listen and ask pertinent questions
  • Able to effectively and timely report representative quality assurance and customer issues, concerns or problems to management
  • Professional attire and manner at all times; continued excellent attendance and punctuality

EDUCATION & EXPERIENCE:

  • Minimum one year CorVel pharmacy benefit management experience
  • Pharmacy Specialist III
  • Certified Pharmacy Technician

PAY RANGE:

CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time.

For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process.

Pay Range: $21.12 - $31.55 per hour

A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management

ABOUT CORVEL:

CorVel, a certified Great Place to Work® Company, is a national provider of industry-leading risk management solutions for the workers’ compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT).

A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off.

CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.

#LI-Hybrid

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