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Tenet Healthcare Quality Management Analyst-Remote in Frisco, Texas

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!

JOB SUMMARY

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:

•Review and analysis of medical management process performance

•Participation 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 beassigned.

  • Performsregular quality review audits on all medical management nurses to ensurecompliance with Conifer Policy and Procedures, federal and state regulations aswell as URAC and industry standards.

  • Participatesin quality initiatives, such as Quality Improvement Projects, Complaints,Member Satisfaction Surveys, and Significant Events through collection,analysis and reporting of data.

  • Takeslead role on all external audits including UM/CM delegation audits and URACaccreditation.Supports URACAccreditation through annual mock audits, tri-annual reaccreditations, andongoing training and education to promote a quality and compliant medicalmanagement program.

  • Supportsall staff and client relations through complex case consultation, participationin client projects, client reporting, monitoring of SLAs, system enhancements,and efficiency initiatives.

  • MaintainsCCCS Policy and Procedures through required review and approval process workingin conjunction with Compliance, Legal, and other departments.

  • MaintainsState Utilization Review Agent licenses.Tracks federal and state regulations updating Policy and Proceduresaccordingly.

  • Providesquarterly QM Audit statistics to Quality Management Committee andleadership.

  • Actsas liaison with delegated entities and vendors including MRIoA, external appealreview IROs, MCG, Language Line, and Relias.

  • SupportsConifer’s Training Department during new hire Orientation as well as ongoingeducation to staff members.

KNOWLEDGE,SKILLS, ABILITIES

To performthis job successfully, an individual must be able to perform each essentialduty satisfactorily. The requirements listed below are representative of theknowledge, skill and/or ability required. Reasonable accommodations may be madeto enable individuals with disabilities to perform the essential functions.

  • Competencyin Microsoft Word, Excel, Adobe, Power Point

  • Analyticaland criterial thinking skills

  • Abilityto problem solve independently

  • Workingknowledge of the healthcare system

  • Excellentwritten communication skills with ability to write in a professional,business manner

  • Abilityto develop creative solutions to complex problems

  • Understandingof CMSA Standards of Practice and Professional Code of Ethics

  • Understandingof relevant legislation, such as HIPAA, MHPAEA, ADA, ACA

  • Excellentverbal communication skills

EDUCATION /EXPERIENCE

Include minimum education, technicaltraining, and/or experience preferred to perform the job.

  • Bachelor’sDegree in Nursing is preferred

  • Atleast 3 years’ experience in Population Health, Case Management, DiseaseManagement, Utilization Management

  • Largeknowledge of Conifer Core Outcomes Optimization functionality andreporting applications

REQUIRED CERTIFICATIONS/LICENSURE

Include minimum certification requiredto perform the job.

  • Active, unrestricted nurse license in State of Residence

  • Certification in Case Management, Healthcare Quality, orsimilar certification related to medical management

PHYSICALDEMANDS

Thephysical demands described here are representative of those that must be met byan employee to successfully perform the essential functions of this job.Reasonable accommodations may be made to enable individuals with disabilitiesto perform the essential functions.

  • Must be able to work in sitting position, usecomputer and answer telephone

  • Ability to travel

  • Includes ability to walk through hospital-based departmentsacross broad campus settings, including Emergency Department environments

WORK ENVIRONMENT

The workenvironment characteristics described here are representative of those anemployee encounters while performing the essential functions of this job.Reasonable accommodations may be made to enable individuals with disabilitiesto perform the essential functions.

  • Office Work Environment

TRAVEL

  • Approximately 5% travel may be required

Job: Conifer Health Solutions

Organization:

Title: Quality Management Analyst-Remote

Location: TX-Frisco

Requisition ID: 2005031327

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