Role Description

Reporting to the Vice President of Quality Assurance, the Regional Quality Assurance Manager is responsible for facilitating and assuring in home care service provision is compliant with applicable Medicaid, Medicaid waiver, MCO, and other licensure and contractual requirements throughout Michigan, Ohio, Delaware, Pennsylvania and Tennessee.

This is a fully remote role.

Essential Duties

• Develop, review, revise and implement standardized state specific policies, procedures and work processes that comply with Medicaid and other regulatory/contractual payer agreements.
• Educate branch leadership and staff on state regulatory and contract requirements.
• Perform on-site and desktop audits and monitoring to assess branch level compliance with applicable rules and regulations.
• Oversee and support external agency audit processes including audit preparation, deficiency remediation and corrective action planning.
• Monitor corrective action execution and drive accountability.
• Drive operational compliance and quality outcomes.
• Report internal and external audit findings at all levels including branch, regional and senior leadership.
• Facilitate investigation, reporting and resolution of critical incidents and complaints.
• Investigate requests for recoupments by reviewing records and documentation.
• Perform other duties as assigned.

Performance Responsibilities

• Maintain positive internal and external customer service relationships.
• Maintain open lines of communication.
• Plan and organize work effectively and ensure its completion.
• Meet all productivity requirements.
• Demonstrate team behavior and promote a team-oriented environment.
• Actively participate in Continuous Quality Improvement.
• Represent the organization professionally at all times.

Qualifications

• Bachelor’s Degree in Business, Social Services, Public Administration, Nursing or a related field of study.
• 3 – 5 years of experience in health care, social services or a related industry.
• Audit experience is preferred.
• Some experience in a large, fast-paced, results-driven, multi-site organization.
• Must possess strong communication, written, interpersonal and organizational skills.
• Proficiency in using Microsoft Word, Excel, PowerPoint and Outlook, required.
• Ability to travel up to 75%. Position may work remotely.
• Must be self-confident, thorough, and prompt in completing assignments and projects.
• Passionate, energetic, tenacious and resolute, with a high sense of urgency and a strong drive to produce results.
• Valid Driver’s License.

Benefits

• Medical, Dental and Vision Benefits.
• Continued Education.
• PTO Plan.
• Retirement Planning.
• Life Insurance.
• Employee discounts.
• Company matched 401K.