Provider Programs Manager jobs in North Carolina

Position Description: Quality Assurance Manager

Under the direction of the Program Manager for the Independent Dispute Resolution Entity (IDRE) or their delegate, the Quality Assurance Training Manager is responsible for training development, training and leading a team to ensure company standards are met. The Quality Assurance Manager is responsible providing quality assurance metrics for the IDRE program and utilizing continuous quality improvement as needed. Outcomes are shared with program management and corporate senior leadership. The Quality Assurance Manager oversees the Quality Assurance Program. The Quality Assurance Manager also provides day to day direction for Quality Assurance Analysts in support of program goals.

Responsibilities:

• Understand and represent PRITM 's mission, vision, and values to all internal and external customers
• Interact with government and private sector clients, partners, and PRITM staff in a professional and accountable manner, and as a representative of PRITM management
• Engage clients in appropriate communication that manages client expectations and builds a collaborative relationship with the client
• Proactively manages and coordinates activities to ensure timeliness of deliverables to exceed contractual obligations
• Interact with project team members in order to successfully fulfill contract obligations with the highest quality and in a timely manner meeting PRITM 's ISO requirements
• Instills integrity throughout the organization via active participation in ISO requirements including but not limited to timely submission of Corrective Action Plans for all matters in which either PRITM standards and/or corporate contract standards have not been met. Communicating outcomes to team members to ensure a positive, open, environment which mitigates risk and achieves a culture of Continuous Quality Improvement.
• Communicates program goals and deadlines to team members
• May plan workloads and delegation of tasks to meet daily goals
• Creates a productive work environment for the team using gamification, trust and other appropriate strategies
• Assesses team performance and provides feedback to employees
• Assists with hiring and training employees
• Assists with the daily operation of the organization specific to team responsibilities
• Provides teams with information and supports recent developments, programs and policy changes of management
• Contributes to business development efforts for new sales and marketing to promote the business through professional communications, sound decisions and by exceeding all contract timeframes and deliverable requirements,
• Utilize project resources for research and reference verification
• Demonstrates skill and experience in handling a large workload with varying deliverable dates
• Flexible with assignments to meet contract performance metrics
• Participates in interdisciplinary collaboration with PRI staff, recognized teaming partners, and/or subcontractors
• Demonstrates skill and experience in the submission of timely, accurate deliverables
• Demonstrated experience and skills in excellent customer service
• Proven skill and experience in excellent oral and written communication spanning executives to the general public
• Experience in analyzing, examining, adjudicating and resolving medical claims under the No Surprise Act or other similar federal law.
• Interact with government and private sector clients, partners, and PRITM staff in a professional and accountable manner, and as a representative of PRITM
• Maintains knowledge and ability to perform duties of Eligibility Insurance Specialist and Health Insurance Specialist positions to ensure contract metrics are met
• Maintains knowledge and ability to perform and provide quality assurance of independent dispute resolution review and payment adjudication activities as needed
• Perform other duties as requested
• Proven skill and experience in excellent oral and written communication spanning executives to the general public
• Maintains a focus of Continuous Quality Improvement in the development of best practices based upon measurable outcomes
• Provides remediation training as appropriate
• Develop training for new staff and continuous training for existing staff
• Conducts random and focused QA with expectation of scores of 98% or better; conducts individualized training and/or group training when indicated.
• Develops training modules in coordination with Instructional System Designers
• Develops job aids in coordination with Instructional System Designers
• Collaborates with Education & Outreach division to ensure course materials are visually appealing and enhance the learning experience.
• Coordinates with human resources course publication based upon staff role as appropriate.
• Perform other duties as requested