Market Clinical Quality Specialist II
Core
Conduct case/file reviews to ensure adherence to regulatory requirements and SOPs for Care Management services.
Role type
Clinical Quality Specialist (Care Management)
Builds
Regulatory compliance reports and quality monitoring for health services
Domain
Healthcare / Medicaid and Medicare
Deliverable
dashboards & analysis
Required skills
Case review, regulatory compliance, SOP adherence, inter-rater reliability monitoring, training development, reporting, project coordination, technical writing, problem solving
Preferred skills
Subject matter expertise, cross-functional collaboration, improvement initiative facilitation
Technologies
Microsoft Excel, Access, Word, SharePoint, PowerPoint, Visio
Responsibilities
Monitor case reviews for regulatory compliance, develop training materials, report on case review aggregates, participate in interdepartmental workgroups, track changes in Federal/State requirements, implement quality improvement initiatives
Seniority
Mid-level, hands-on IC