Utilization Review and Quality Assurance Specialist
2 weeks ago
Position Overview:
The Quality and Utilization Management Specialist plays a pivotal role in overseeing and coordinating the interdepartmental processes related to the monitoring and submission of Utilization Review (UR) state licenses. This position collaborates closely with legal teams and industry experts to ensure adherence to regulatory standards for licensing and compliance while effectively communicating essential information to both internal and external stakeholders.
Key Responsibilities:
- Maintain comprehensive documentation and tracking of all licensing requirements and application statuses.
- Collaborate with internal departments and external vendors to ensure timely completion and submission of licensing requirements.
- Work alongside legal teams to monitor state licensing requirements and implement necessary changes.
- Assist in the development, implementation, and monitoring of quality improvement and utilization management initiatives.
- Support the maintenance of policies, procedures, and processes related to RBUM.
- Contribute to quality improvement initiatives, including the monitoring, auditing, and tracking of the Utilization Management Program.
- Coordinate with various departments to assist in conducting required internal audits for Utilization Management.
- Partner with management to create quality assurance plans, facilitate strategy implementation, and review documentation for accuracy.
- Support URAC and NCQA accreditation standards and surveys, as well as any other relevant accreditation programs.
- Assist with client audits and routine compliance tasks as needed.
- Perform additional responsibilities as assigned by management.
Qualifications:
Experience:
- Minimum of 2 years of relevant experience.
Education:
- High School Diploma or GED (Required).
Preferred Skills:
- Proven ability to manage daily activities and projects independently, adhering to deadlines.
- Strong written communication skills and experience in document preparation.
- Exceptional organizational skills with a keen attention to detail.
Additional Experience:
- Experience in organizing, tracking, and trending information.
- Familiarity with Utilization Management Licenses across the nation.
- Experience with NCQA/URAC accreditation processes.
- Background in internal auditing.
Education:
- Associate's degree or equivalent experience in compliance is preferred.
Certifications:
- CHC certification is preferred.
Working Conditions:
- This position is primarily remote with no travel requirements.
Physical Demands:
- Primarily sedentary work, requiring minimal physical exertion.
Compensation and Benefits:
Premier offers a competitive salary range and a comprehensive benefits package, including health, dental, vision, life and disability insurance, a 401k retirement program, paid time off, and opportunities for professional development.
About Premier:
- Recognized as one of the healthiest employers and one of the world's most ethical companies.
- Committed to transforming the healthcare industry through innovation and collaboration.
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Charlotte, North Carolina, United States Premier, Inc. Full timePosition Overview:The Quality and Utilization Management Specialist is a pivotal role responsible for overseeing interdepartmental collaboration in the monitoring and submission processes for initial and renewal applications related to Utilization Review (UR) state licenses. This position necessitates close cooperation with legal teams and industry experts...
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Charlotte, North Carolina, United States Premier, Inc. Full timePosition Overview:The Quality and Utilization Management Specialist is tasked with overseeing and facilitating interdepartmental collaboration to monitor and prepare submissions for the initiation and renewal of Utilization Review (UR) state licenses. This role necessitates close cooperation with legal teams and industry experts to conduct regulatory...
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Charlotte, North Carolina, United States Premier, Inc. Full timePosition Overview:The Quality and Utilization Management Specialist will serve as the primary point of contact for interdepartmental collaboration in overseeing and preparing submissions for the initiation and renewal of Utilization Review (UR) state licenses. This role necessitates close cooperation with legal teams and industry experts to conduct thorough...
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Charlotte, North Carolina, United States Premier, Inc. Full timePosition Overview:The Quality and Utilization Management Specialist is a pivotal role responsible for the comprehensive oversight of interdepartmental collaboration in monitoring and preparing submissions for the initiation and renewal of Utilization Review (UR) state licenses. This position necessitates close cooperation with legal teams and industry...
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