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Clinical Quality Assurance Manager

4 months ago

Gilbert, United States Arkos Health Full time

**Our Organization**:
Welcome to Arkos Health We are a value-based healthcare company providing solutions for payors and providers by combining unique technology with in-home, virtual, and in-clinical care for patients. Backed by a robust technology platform, innovative software, and a light human touch, Arkos Health is committed to delivering advanced and accessible community-based services allowing our clients to live healthier, more independent lives. How do we do this? Arkos serves health plans and provider organizations by managing their highest-risk and highest-cost populations. Our goal is to be the most valued partner to health plans, service providers, and the community we collectively serve.

**How You'll Make a Difference**:
**Essential Duties and Responsibilities**:
- Monitor and investigate call-audit activities, provide clinical guidance/recommendations for call audit escalations
- Standardization of call audit tools; ensuring alignment with current state/federal compliance requirements.
- Analyze quality performance and regulatory compliance through call logs and data collection
- Prepare and maintain QA report summaries focused on call audit performance, quality benchmark thresholds, emerging trends, and deficiencies.
- Develop call-audit training materials, reference guides, and visual aids to support internal call-center support departments
- Develop call audit inter-rater reliability (IRR) tracking tool to measure performance, volume, and productivity.
- Provide clinical quality leadership to internal department management teams.
- Work with market managers/directors to identify role/market/contract specific modifiers for call performance.
- Departmental collaboration with the QA Director, to establish “best practice” guidelines for staff speaking with patients, i.e., motivational interviewing, de-escalation, “selling” programs and services.
- Develop and or maintain internal call audit policies and procedures.
- Must be knowledgeable of NCQA HEDIS performance measures and provide clinical interpretation of specific member engagement calls focused on gaps-in-care.

**Qualifications and Skills**:

- Knowledge of Medicare, Medicaid, and Marketplace lines of business and applicable regulatory requirements.
- Five years or more of clinical quality assurance experience in a managed-care setting.
- Must have critical thinking and healthcare analytics experience.
- Ability to communicate effectively with all levels of internal staff (clinical and non-clinical).
- Ability to be detailed-oriented and prioritize in high-pressure environments.
- Ability to work both independently and as part of a team with mínimal supervision.
- Demonstrated ability to plan, coordinate, and evaluate Quality Assurance (QA) and Performance Improvement (PI) activities
- Effective oral and written communication skills and proficiency in basic computer skills required.
- Working knowledge of staff development and the educational process, quality improvement, continuous process/performance improvement methodology.
- Current unrestricted nursing license - BSN preferred.

**Benefits**:

- Employer-paid Medical premiums at no cost to you
- Employer-paid Dental premiums at no cost to you
- Employer-paid Vision premiums at no cost to you
- Employer-paid Short-Term Disability premiums at no cost to you
- Employer-paid Life Insurance premiums at no cost to you
- Employer matching 401(k)
- 15 days annual combined sick/vacation and 9 days of holiday during your first year
- Your Birthday off

Arkos Health EEO Statement:
We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or expression, pregnancy, age, national origin, disability status, genetic information, protected veteran status, or any other characteristic protected by law.

Arkos Health is a drug-free workplace. All job applicants selected for employment are required to submit to a pre-employment drug test and background check.