WellSky

Compensation

Full Description

Description: • Facilitate activities related to performance measurement and outcomes, ensure the organization meets CMS, NCQA, and other regulatory standards, stay updated on relevant regulatory changes, and support their integration into practices. • Comply with state, federal, and organizational standards by assisting in the development and enforcement of policies aligned with Utilization Management and Quality Improvement Program requirements. • Guide the implementation of internal audit protocols in compliance with CMS regulations and NCQA standards, and contribute to the consistency of clinical documentation and decision-making processes. • Analyze data to identify trends and areas for improvement, and execute defined projects aimed at enhancing care quality across various lines of business. • Generate and validate reports to monitor performance and compliance across health plan contracts, ensuring accuracy and alignment with requirements. • Prepare for regulatory, accreditation, and contractual audits, and contribute to the remediation and documentation of audit findings. • Perform other job duties as assigned Requirements: • Bachelor's Degree or equivalent work experience • At least 4-6 years of relevant experience in healthcare quality management and post-acute care utilization management • Preferred: Registered Nurse, Occupational Therapist, or Physical Therapist with a bachelor’s degree in a related field, or a combination of education and experience that includes pertinent clinical experience and an understanding of CMS standards and guidelines • Experience with CMS and/or NCQA audits • Ability to manage multiple competing priorities and tasks effectively • Strong written, oral, and interpersonal communication skills • Demonstrated ability to collaborate with external vendors and clients • Proficiency in manipulating and sorting data for analytics and reporting • Excellent analytical and data interpretation skills • Experience in case management in a healthcare setting • Applicants for U.S.-based positions must be legally authorized to work in the United States • Certain client-facing positions may be required to comply with applicable requirements, such as immunizations and occupational health mandates Benefits: • Excellent medical, dental, and vision benefits • Mental health benefits through TelaDoc • Prescription drug coverage • Generous paid time off, plus 13 paid holidays • Paid parental leave • 100% vested 401(K) retirement plans • Educational assistance up to $2500 per year