QA Manager - DC

Job Description

Job Description

LOCATION: ON-SITE in the DISTRICT OF COLUMBIA

SUMMARY

Oversees and directs the complaint, grievance, appeals, and quality assurance programs to provide timely, compliant, and effective resolution of beneficiary concerns and adherence to established quality and performance standards. Manages the dedicated complaint and grievance telephone line, related staff and daily operations, and associated fiduciary responsibilities. Plans, coordinates, and implement quality assurance initiatives designed to monitor service delivery, identify opportunities for improvement, and guarantee consistency with contractual, regulatory, and organizational standards. Performs these responsibilities directly and through subordinate supervisors and staff.

ESSENTIAL FUNCTIONS

• Formulates and maintains quality assurance objectives complementary to corporate policies and goals. Interprets quality assurance philosophy to key personnel in organization.
• Performs quality engineering reviews of design documentation for compliance with stated requirements, including vendor quality manuals and company quality records.
• Applies statistical process control (SPC) methods for analyzing data to evaluate the current process and process changes.
• Reviews all data obtained during all quality assurance activities to ensure consistency with company policies and procedures. Develops new approaches to solve problems identified during quality assurance activities.
• Keeps Management team abreast of significant issues or developments identified during quality assurance activities and actions being taken to improve the situation. Prepares and presents technical and program information to the management team. Directs technical and administrative workers engaged in quality assurance activities.
• Maintains a working knowledge of government and industry quality assurance codes and standards.
• Plays an active role on quality management teams within the organization.
• Designs and implements quality assurance training programs to key personnel in conjunction with managers.
• Investigates and adjust customer complaints regarding quality.

QUALIFICATIONS REQUIRED

• Experience with root cause analysis, case tracking, reporting, and regulatory compliance,
• Knowledge of Medicaid grievance and appeal processes and relevant federal/state regulations.
• Experience in complaints, grievances management, appeals, and member services within healthcare, managed care or regulatory environment.
• Project management skills, knowledge of healthcare, Medicaid programs, experience with low-income populations; and leadership experience.

MINIMUM REQUIRED EDUCATION/TRAINING

• 5+ years experience
• Bachelor’s degree from an accredited institution in either of the following: Healthcare

administration, public health, business administration, social work or a related field.