Clinical Quality Assurance Auditor

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Modivcare

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Healthcare Insurance • Transport

Modivcare is a company that focuses on simplifying the experience of living with complex healthcare needs by providing a comprehensive suite of supportive care solutions. They specialize in non-emergency medical transportation, personal care, and virtual & remote patient monitoring. Modivcare works closely with Medicaid Plans, State Agencies, Medicare Advantage, SNP Plans, health systems, healthcare professionals, and transportation providers, ensuring that members receive necessary health services. Through innovative technology and data-driven strategies, they address social determinants of health by offering services like quality transportation, chronic care management, meal delivery, and in-home assistance, aimed at optimizing patients' health outcomes and improving their overall experience.

10,000+ employees

Founded 2017

⚕️ Healthcare Insurance

🚗 Transport

💰 $525M Post-IPO Debt on 2024-07

📋 Description

• Implements audit strategies to assess the quality of calls, compliance with healthcare regulations, and overall adherence to quality standards. • Conduct audits on calls, clinical charts, processes, procedures, and systems to ensure adherence to industry standards. • Process and respond to unresolved escalations (issues that arise in calls that are unable to be resolved in the moment), working closely with relevant teams to address issues and provide timely resolutions. • Complete reviews of clinical escalations resulting from outlier biometrics for process and quality recommendations. • Communicates audit findings, analysis, and recommendations to senior management and key stakeholders. • Highlight trends, actionable insights, and areas requiring improvement. • Collaborates with internal teams to identify action plans and implement corrective actions based on audit findings. • Tracks and monitors the progress of these action plans. • Provides coaching and development to team members on job skills, delivery skills, and quality improvement. • Offers targeted support for individuals needing additional coaching on soft skills or specific job tasks to enhance team performance. • Ensures ongoing compliance with quality standards, industry regulations, and internal policies by extracting and evaluating calls. • Monitors and assists in meeting compliance and productivity goals. • Analyze call data to identify trends, gaps, and areas for improvement. • Prepare reports to share with senior management for decision-making purposes. • Build and maintain strong relationships with internal and external stakeholders, including healthcare providers, patients, and regulatory agencies. • Ensure clear communication of audit results and next steps to involved parties. • Handles routine inquiries and relay information between departments and stakeholders. • Maintains security and access to sensitive materials. • Assists with maintaining productivity and quality goals. • Monitors and assists with QA chat channels to provide real-time support. • Performs other duties as assigned by management.

🎯 Requirements

• Bachelor's Degree in health related field required. • Five (5) plus years of clinical experience. • Current and unobstructed RN licensure (Preferred) • Strong attention to detail and organizational skills. • Collaborative and team-oriented approach. • Ability to handle sensitive and confidential information. • Problem-solving mindset and proactive in addressing challenges. • Adaptable and flexible in responding to changing business needs. • Strong knowledge of industry regulations, compliance standards, and audit processes. • Excellent analytical skills with the ability to identify trends and provide actionable insights. • Strong communication skills, both written and verbal, with the ability to report findings and collaborate with various departments. • Experience in coaching and training team members to improve performance and achieve quality goals. • Ability to work independently, prioritize tasks, and manage multiple projects simultaneously. • Familiarity with clinical processes and the handling of clinical escalations is a plus. • Proficiency in quality assurance software, data analysis tools, and Microsoft Office Suite (Excel, Word, PowerPoint).

🏖️ Benefits

• Medical, Dental, and Vision insurance • Employer Paid Basic Life Insurance and AD&D • Voluntary Life Insurance (Employee/Spouse/Child) • Health Care and Dependent Care Flexible Spending Accounts • Pre-Tax and Post --Tax Commuter and Parking Benefits • 401(k) Retirement Savings Plan with Company Match • Paid Time Off • Paid Parental Leave • Short-Term and Long-Term Disability • Tuition Reimbursement • Employee Discounts (retail, hotel, food, restaurants, car rental and much more!)