As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!
The Quality Management Analyst, under the direction of the Director of Medical Management Quality, supports the initiatives that maintain and/or improve the quality of CCCS medical management services. Quality Management Analyst responsibilities include but are not limited to:
ï¿½Review and analysis of medical management process performance
ï¿½Participation in the processes necessary for compliance with federal and state law and standards of CCCS accreditation bodies.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Include the following. Others may be assigned.
Performs regular quality review audits on all medical management nurses to ensure compliance with Conifer Policy and Procedures, federal and state regulations as well as URAC and industry standards.
Participates in quality initiatives, such as Quality Improvement Projects, Complaints, Member Satisfaction Surveys, and Significant Events through collection, analysis and reporting of data.
Takes lead role on all external audits including UM/CM delegation audits and URAC accreditation.Supports URAC Accreditation through annual mock audits, tri-annual reaccreditations, and ongoing training and education to promote a quality and compliant medical management program.
Supports all staff and client relations through complex case consultation, participation in client projects, client reporting, monitoring of SLAs, system enhancements, and efficiency initiatives.
Maintains CCCS Policy and Procedures through required review and approval process working in conjunction with Compliance, Legal, and other departments.
Maintains State Utilization Review Agent licenses.Tracks federal and state regulations updating Policy and Procedures accordingly.
Provides quarterly QM Audit statistics to Quality Management Committee and leadership.
Acts as liaison with delegated entities and vendors including MRIoA, external appeal review IROs, MCG, Language Line, and Relias.
Supports Coniferï¿½s Training Department during new hire Orientation as well as ongoing education to staff members.
KNOWLEDGE, SKILLS, ABILITIES
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Competency in Microsoft Word, Excel, Adobe, Power Point
Analytical and criterial thinking skills
Ability to problem solve independently
Working knowledge of the healthcare system
Excellent written communication skills with ability to write in a professional, business manner
Ability to develop creative solutions to complex problems
Understanding of CMSA Standards of Practice and Professional Code of Ethics
Understanding of relevant legislation, such as HIPAA, MHPAEA, ADA, ACA
Excellent verbal communication skills
EDUCATION / EXPERIENCE
Include minimum education, technical training, and/or experience preferred to perform the job.
Bachelorï¿½s Degree in Nursing is preferred
At least 3 yearsï¿½ experience in Population Health, Case Management, Disease Management, Utilization Management
Large knowledge of Conifer Core Outcomes Optimization functionality and reporting applications
Include minimum certification required to perform the job.
Active, unrestricted nurse license in State of Residence
Certification in Case Management, Healthcare Quality, or similar certification related to medical management
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Must be able to work in sitting position, use computer and answer telephone
Ability to travel
Includes ability to walk through hospital-based departments across broad campus settings, including Emergency Department environments
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Office Work Environment
Approximately 5% travel may be required
Job: Process & Analyst
Primary Location: Frisco, Texas
Job Type: Full-time
Shift Type: Days
Employment practices will not be influenced or affected by an applicantâ��s or employeeâ��s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.
Internal Number: 2005031327
About Conifer Health Solutions
Tenet Healthcare Corporation is a diversified healthcare services company with 115,000 employees united around a common mission: to help people live happier, healthier lives. Through its subsidiaries, partnerships and joint ventures, including United Surgical Partners International, the Company operates general acute care and specialty hospitals, ambulatory surgery centers, urgent care centers and other outpatient facilities. Tenet's Conifer Health Solutions subsidiary provides technology-enabled performance improvement and health management solutions to hospitals, health systems, integrated delivery networks, physician groups, self-insured organizations and health plans.