Quality Assurance Manager

Position Description:

Quality Assurance Manager Under the direction of the Program Manager for the Independent Dispute Resolution Entity (IDRE) or their delegate, the Quality Assurance Training Manager is responsible for training development, training and leading a team to ensure company standards are met. The Quality Assurance Manager is responsible providing quality assurance metrics for the IDRE program and utilizing continuous quality improvement as needed. Outcomes are shared with program management and corporate senior leadership. The Quality Assurance Manager oversees the Quality Assurance Program. The Quality Assurance Manager also provides day to day direction for Quality Assurance Analysts in support of program goals. Responsibilities: Understand and represent

PRITM

's mission, vision, and values to all internal and external customers Interact with government and private sector clients, partners, and

PRITM

staff in a professional and accountable manner, and as a representative of

PRITM

management Engage clients in appropriate communication that manages client expectations and builds a collaborative relationship with the client Proactively manages and coordinates activities to ensure timeliness of deliverables to exceed contractual obligations Interact with project team members in order to successfully fulfill contract obligations with the highest quality and in a timely manner meeting

PRITM

's ISO requirements Instills integrity throughout the organization via active participation in ISO requirements including but not limited to timely submission of Corrective Action Plans for all matters in which either

PRITM

standards and/or corporate contract standards have not been met. Communicating outcomes to team members to ensure a positive, open, environment which mitigates risk and achieves a culture of Continuous Quality Improvement. Communicates program goals and deadlines to team members May plan workloads and delegation of tasks to meet daily goals Creates a productive work environment for the team using gamification, trust and other appropriate strategies Assesses team performance and provides feedback to employees Assists with hiring and training employees Assists with the daily operation of the organization specific to team responsibilities Provides teams with information and supports recent developments, programs and policy changes of management Contributes to business development efforts for new sales and marketing to promote the business through professional communications, sound decisions and by exceeding all contract timeframes and deliverable requirements, Utilize project resources for research and reference verification Demonstrates skill and experience in handling a large workload with varying deliverable dates Flexible with assignments to meet contract performance metrics Participates in interdisciplinary collaboration with PRI staff, recognized teaming partners, and/or subcontractors Demonstrates skill and experience in the submission of timely, accurate deliverables Demonstrated experience and skills in excellent customer service Proven skill and experience in excellent oral and written communication spanning executives to the general public Experience in analyzing, examining, adjudicating and resolving medical claims under the No Surprise Act or other similar federal law. Interact with government and private sector clients, partners, and

PRITM

staff in a professional and accountable manner, and as a representative of

PRITM Maintains knowledge and ability to perform duties of Eligibility Insurance Specialist and Health Insurance Specialist positions to ensure contract metrics are met Maintains knowledge and ability to perform and provide quality assurance of independent dispute resolution review and payment adjudication activities as needed Perform other duties as requested Proven skill and experience in excellent oral and written communication spanning executives to the general public Maintains a focus of Continuous Quality Improvement in the development of best practices based upon measurable outcomes Provides remediation training as appropriate Develop training for new staff and continuous training for existing staff Conducts random and focused QA with expectation of scores of 98% or better; conducts individualized training and/or group training when indicated. Develops training modules in coordination with Instructional System Designers Develops job aids in coordination with Instructional System Designers Collaborates with Education & Outreach division to ensure course materials are visually appealing and enhance the learning experience. Coordinates with human resources course publication based upon staff role as appropriate. Perform other duties as requested Position Requirements

Requirements: Bachelor’s Degree in Health Administration, or other healthcare related work experience Experience training, education, managing, supervising, and leading team Experience with tools and techniques of continuous quality improvement Experience with motivational interviewing and coaching is preferred Ability to multitask, work well under pressure and within timelines Strong analytical and problem solving skills with the ability to communicate solutions Excellent written and verbal communication skills Reliable and trustworthy; Integrity is required Excellent organizational skills and ability to pay attention to detail Ability to contribute to and work effectively within a team environment Ability to interface with management and staff personnel Proficient user of Microsoft office suite such as Outlook, Access, Excel and Word Ability to be discrete and maintain confidentiality Must have no adverse actions pending or taken against him/her by any State or Federal licensing board or program Must have no conflict of interest (COI) as defined in 1154(b)(1) of the Social Security Act (SSA) Ability to obtain and maintain U.S. Government Security Clearance Preference will be given to those individuals who reside in, or are willing to relocate to, a recognized HUBZone area. (Go to www.sba.gov/hubzone

for more information). FLSA status: Exempt Contract Compensation Plan PRI is an equal employment opportunity employer. All qualified applicants including Disability/Vets or other qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, disability status, protected veteran status or any other characteristic protected by law. Degree Certification Specialty/Subspecialty Position

Quality Assurance Manager Location

Provider Resources Inc - Madison, WI (Monona) EOE Statement

PRI is an equal employment opportunity employer. All qualified applicants including Disability/Vets or other qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, disability status, protected veteran status or any other characteristic protected by law. This position is currently accepting applications. Medical Review Nurse (MRN)

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