Quality Manager

Emploi pas sur LinkedIn

🕒 il y a 1 jour

🏖️ New Jersey – Distant

🏖️ New Jersey – Remote

💵 $60 000 - $65 000 / an

⏰ Temps Plein

🟡 Intermédiaire

🟠 Senior

👔 Manager

👻 Score fantôme 0%

Ce que ça veut dire : la probabilité que cette offre reste ouverte sans recrutement actif.Comment le lire : 60 % ou plus, on pense que c'est une offre fantôme. Un score plus bas est moins inquiétant.Comment on la calcule : ancienneté, republications, postes ouverts vs taille de l'équipe, rapidité de clôture, et si le salaire est indiqué.À noter : une estimation à partir de données publiques, pas un jugement sur l'entreprise. De vraies offres peuvent avoir un score élevé, alors prenez-le comme un indice, pas comme un fait.

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Abound Health

Site WebLinkedInTous les Emplois

1001 - 5000 employés

Fondée en 1997

💼 Conseil

🏥 Santé

🤝 À but non lucratif

Consulting • Healthcare • Non-profit

Abound Health s'engage à autonomiser les personnes de tous âges ayant des déficiences intellectuelles et développementales (I/DD) ainsi que des besoins médicaux complexes. Ils offrent une gamme de services, y compris des foyers de groupe, des emplois assistés et des services consultatifs spécialisés, tous axés sur une prise en charge centrée sur la personne. Leur mission souligne l'importance de la défense des droits, de l'inclusion et du soutien non seulement aux individus mais aussi à leurs familles et leur personnel.

Description

• Lead New Jersey-specific quality and compliance priorities, workplans, and operating processes • Serve as the New Jersey subject-matter lead for quality, compliance, contract requirements, and payer expectations • Partner with operations and clinical teams to embed quality and compliance into daily operations, onboarding, supervision, and service delivery • Maintain knowledge of New Jersey DDD requirements and documentation standards and translate requirements into workflows and training • Partner with billing and finance to monitor claims quality, denials, recoupments, and audit activity and drive corrective actions • Oversee payer audit preparation and responses, including medical record requests and pre- and post-payment reviews • Support the identification, documentation, and resolution of potential overpayments • Oversee the New Jersey incident management process, including timely reporting and tracking of reportable incidents • Lead or support investigations and root-cause analysis for incidents, complaints, and grievances • Develop and monitor Plans of Correction following investigations • Coordinate accreditation and external reviews as applicable • Design and execute New Jersey audit and monitoring plans covering documentation, authorizations, contract deliverables, incidents, credentials, and billing support • Establish and monitor quality and compliance dashboards and KPIs • Provide routine reporting to leadership and escalate material risks and trends • Represent quality and compliance in New Jersey payer, DDD, and contract partner interactions as requested • Report to the EVP of Quality & Compliance and partner with operational, clinical, finance/billing, HR, and legal teams

🎯 Exigences

• Bachelor’s degree in Healthcare Administration, Business, Nursing, Social Work, Public Health, Quality, Compliance, or a related field • 5+ years of progressive experience in healthcare quality/compliance • Direct experience with payer requirements, contract compliance, and incident reporting in a regulated environment • Experience in behavioral health, I/DD, HCBS, or a similar setting preferred • Experience with New Jersey DDD, Medicaid Waiver, or NJ FamilyCare requirements strongly preferred • Knowledge of compliance programs, auditing/monitoring, credentialing, corrective action, and training programs • Working knowledge of New Jersey incident reporting requirements, background check/CARI processes, and mandatory reporting laws • Ability to interpret contracts, payer manuals, and regulations and translate them into practical operational processes • Strong communication, collaboration, project management, and analytical skills • Ability to influence and collaborate effectively across teams

🏖️ Avantages

• Comprehensive benefits package • Competitive health/dental/wellness coverage • 401(k) eligibility after 12 months • Full-time position