Claims Quality Audit Director jobs in the United States

Our Company

BrightSpring Health Services

Overview

The Quality Audit Director partners with operations and other support teams to ensure quality, integrity in services, stability, and process efficiency in operations through inspection, auditing, and collaboration. Ensures adherence to audit schedules. Communicates audit results and trends with local managers, upline management, and corporate departments. Provides education during the audit process and makes recommendations for development or revision to policy, process, education, best practices, etc. based on audit results. Ensures that the audit itself is updated and measures service quality, fosters compliance with internal and external requirements, and provides education for field operations regarding requirements and the audit process.

Responsibilities

• Develops and implements the auditing policies and procedures• Participates in meetings with internal departments to gather information and ensure that the audit/assessment tools continue to measure critical indicators of success and address audit/company objectives• Ensures continuous learning and development of skillsets needed to perform a comprehensive quality audit and provide required direction to the audit team as well as field operations to improve performance• Oversees and ensures that the audit is completed for all applicable operations at the frequency determined (after baseline is established, a frequency is determined based on prior audit performance)• Completes audits, provides education for operations staff regarding requirements and audit process, and meets targets for reviews• Ensures that the quality audit tools are updated and measure service quality and fosters compliance with internal and external requirements • Communicates audit results/trends to operations managers/leadership, operations support team, and any/all pertinent corporate departments• Makes recommendations for revisions in policy/education/training• Reviews and prepares written reports to communicate observations and redesign recommendations• Facilitates compliance with corporate policies and legal requirements and reports audit findings that would put the company at risk to senior management and the Chief Compliance Officer and/or Legal Department• Works with regional operations and quality leadership to identify priorities, determine operational needs, and recommend actions to drive improvement• Provides expertise regarding policy interpretation, process improvement, and follow-up actions required• Uses data from additional sources such as audits, Critical Incidents, Satisfaction Surveys, and regulatory reviews to prioritize operations for audit and guide recommendations for revision to quality improvement goals and objectives• Reinforces the consistent utilization of the company’s risk management systems to maximize the safety and security of employees and those receiving services• Maintains expert knowledge related to accreditation standards, compliance and regulatory requirements, and review processes• Supports operations to provide services in an ethical and lawful manner• Keeps abreast of all company policies and procedures, local, state, and federal laws and regulations, and applicable accreditation standards• Accountable to proactively identify issues and request assistance up-line as indicated• Ensures and coordinates communications and information between corporate departments, field operations, and the quality audit team • Participates in special projects and performs related duties as assigned

Qualifications

• Bachelor’s Degree in human services, education, social work, nursing, or a related field required• 3-5 years prior work experience in Community Living, HomeCare required• Prior experience in conducting audits/quality reviews preferred• Must be able to work independently• Requires excellent written and oral communication skills• Proven ability to manage multiple priorities• Working knowledge of regulatory requirements for assigned Line of Business• Excellent computer skills including Microsoft Word, Excel, and PowerPoint• Must be willing to work flexible hours• Requires up to 100% travel across multiple states• Reviews will be completed in the operations to include residential homes, day programs, host/foster family homes, client homes, and offices• Remote work such as electronic record reviews, developing reports, and preparation can be completed at home offices

About our Line of Business

Salary Range