Job ID: J111263
Company: Gateway Health Plan
Location: Pittsburgh, PA, United States
Full/Part Time: Full time
Job Type: Regular
Posted at: Mar 19, 2018
Responsible for working with appropriate departments in the areas of compliance, process improvement and member/provider satisfaction for all product lines (e.g. Medicaid and Medicare Special Needs Plan). Identify/ implement best practices and/or interventions that have potential to improve health outcomes for members and improve quality scores. Recommends and/or implements process improvements related to the potential of quality medical care and service. Serves as a resource regarding accreditation standards including NCQA standards and continuous quality improvement principles. May coordinate accreditation activities on behalf of the organization.
1. Develops, manages process improvement initiatives from member/providers to include detailed data analysis, process analysis, report generation and documentation.
2. Conduct, collect and analyze data from office site and/or medical record reviews to continually improve the care and service to members and coordination with the credentialing and quality improvement programs to achieve and maintain accreditation.
3. Monitor changes, corrections and clarifications in applicable regulatory/accrediting body requirements and make adjustments to the compliance plan.
4. Conduct annual audits, identify gaps, communicate results and re-audit
5. Other duties as assigned or requested.
Knowledge, Skills and Abilities
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