Genex Services Manager, Quality Assurance - Case Management in Atlanta, Georgia
We are currently seeking a Manager, Quality Assurance for our Telephonic Case Management department.
The Manager, Quality Assurance is responsible and accountable for the successful, ongoing development, refinement, implementation, measurement, ongoing quality improvement of the Genex telephonic case management program. Additionally, the position is responsible for the ongoing compliance with URAC and other appropriate standards for activities related to quality case management.
Main responsibilities will include but are not limited to:
Works directly with the Director East UM to plan, organize, identify and implement strategic projects to improve TCM quality and financial outcomes.
Plays an active role in the dissemination of the case management best practices and assists with new business opportunities and implementation.
Encourages and supports development of both clinical and non-clinical case management staff at Genex.
Develop a comprehensive telephonic case management training program to be utilized for onboarding new hires or retraining.
Ensures all eligible telephonic case managers have join eNLC.
Provides input and receives direction from the Director and SVP.
Provides reports to the SVP, Director and/or Branch Manager as requested.
Coordinate TCM staff training for orientation and collaborate with TCM Branch Managers and Supervisors.
Review and Inspect TCM dashboard reports and detail open and closed reports to determine opportunities for improvement and insure data integrity.
Review and Inspect TCM monthly audits/scorecards to determine opportunities for additional training or improvement in delivery of services.
Report to the Director UM any potential problems identified and offer possible solutions.
Establish and maintain effective working relationship with clients and the medical community.
Coordinate ongoing continuing education programs for Genex case management staff.
Coordinate and perform ongoing quality assurance initiatives/programs; participation in corporate QA committee monthly meetings.
Interact with sales staff including assisting with stewardship reporting preparation and other outcomes presentations.
Ensure TCM personnel are following URAC standards and/or client specific account instructions.
Perform other functions as requested to reach Genex goals.
Participates on company committees and task forces as assigned.
Meets with clients and potential clients as necessary to discuss the Genex case management program.
Performs all responsibilities in a manner that fully complies with Genex policies and procedures.
Performs other duties as assigned.
EDUCATION: Diploma, Associates Degree or Bachelor’s Degree in Nursing required. Advanced Degree preferred.
EXPERIENCE: Three to Five years of clinical experience with two years of ICU, CCU or ER preferred. Prior Utilization review/quality assurance/case management/workers’ compensation experience required. Five years of supervisory/management experience.
MINIMUM QUALIFICATIONS: Registered Nurse with current license and CCM.
CERTIFICATES, LICENSES, REGISTRATIONS: Registered Nurse with current license; reciprocal licensure in other states as required by law. CCM, CDMS, CRC, CRRN, COHN, CPUR preferred; CCM eligibility required.
OTHER QUALIFICATIONS: Ability to perform in a matrix management environment.Ability to perform assigned duties with time pressures and frequent interruptions. Ability to utilize general office equipment and other necessary equipment. Ability to utilize personal computer and various software packages. Ability to analyze and resolve difficult problems. Ability to communicate effectively.Ability to travel when necessary.Ability to set priorities. Excellent interpersonal skills. Excellent/exceptional organizational skills. Knowledge of statistical analysis. Ability to work independently. Fully versed in state workers’ compensation laws and practices. Knowledge of additional insurance lines such as STD/LTD and MCO preferred. Computer literacy required. Up to 25% travel required.
CategoryTelephonic Case Management