Job ID: J134693
Company: Gateway Health Plan
Location: Home, PA, United States
Full/Part Time: Full time
Job Type: Regular
Posted at: Nov 12, 2018
This job is responsible for working with appropriate departments in the areas of compliance and process improvement for all product lines. Reviews, researches and responds to clinical data relating to quality of medical care. Recommends and/or implements interventions related to the improvement of medical care and costs. Serves as a corporate resource regarding related accreditation standards including NCQA, CMS, URAC, etc., clinical performance and continuous improvement principles. Coordinates related accreditation activities on behalf of the organization. May perform: special studies or audits, practice guideline development and monitoring, network provider performance measurement and monitoring, activities to educate or influence the behavior of members and/or providers. Acts as subject matter expert for the corporation. While the role will be work from home, the first 6 months will require onboarding in the Gateway offices.
Is Travel Required?
Yes - (The job will involve site visits throughout Pennsylvania with short notice. Work from home will begin after a 3-6 month onboarding period.)
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies
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