Supervisor, Provider Quality Audits

Date: Nov 13, 2021

Location: Rancho Cucamonga, CA, US

Company: Inland Empire Health Plans

Job Requisition ID: 6079 

 

Position Summary/Position

 

Under the direction of the Director of Quality Management, the Supervisor, Provider Quality Audits is responsible for the management, implementation, and monitoring of IEHP’s Potential Quality Incidents (PQI) process. In this capacity, the Supervisor of Provider Quality Audits will lead a team to coordinate cross-functional activities that support PQI-related functions with both internal and external partners.

Major Functions (Duties and Responsibilities)

 

1. Supervise day to day functions of PQI staff to ensure timely and accurate review of cases.
2. Establish clear communication with IEHP Medical Directors to provide information and assistance in support of PQI cases, as needed.
3. Serve as the internal point of contact for IEHP department team members and external partners regarding Potential Quality Incidents regulations and processes.
4. Analyze PQI data for trends and review findings with the Director of Quality Management and present results and recommendations to internal quality committees.
5. Responsible for developing and deploying trainings to both internal team members across the organization and to external provider partners on key requirements for identifying and reporting potential quality incidents (PQIs), in alignment with state and federal requirements.
6. Responsible for the development, maintenance, implementation, and adherence to departmental policies and procedures, standard operating procedures, and job aides.
7. Establish and maintain effective working relationships with others throughout the organization and external partners.
8. Embrace process improvement LEAN concepts to continually improve the PQI team processes, ensuring efficient use of staff resources and meeting internal timeliness and quality standards.

Supervisory Responsibilities

Leader: Administers Hires, Terminations, and Performance Reviews

Experience Qualifications

 

Three (3) years conducting provider clinical audits in a healthcare setting. Three (3) years of experience leading clinical staff on projects that required productivity and quality targets to be met. Three (3) or more years of experience working in a hospital or clinical setting providing patient care. Three (3) or more years of experience in healthcare and an in-depth knowledge of all aspects of managed care operations with extensive knowledge of HMO and IPA operations with an emphasis in Quality Management. Previous experience required, including knowledge of CMS, NCQA, and state regulations related to patient safety and practitioner quality standards.  

Education Qualifications

 

Bachelor’s degree in Nursing from an accredited institution required.

Professional Licenses

 

Possession of an active, unrestricted, and unencumbered Registered Nurse (RN) license issued by the California BRN required.

Knowledge Requirement

 

Working knowledge of managed care, claims payment processes and insurance terminology required.

Skills Requirement

 

Analytical skills, time management, and problem solving.  Microcomputer applications (Microsoft Word and Excel, Access required) for use in all aspects of an office environment. Excellent communication, interpersonal and organizational skills. Must have exceptional communication, writing, documentation, and assessment skills.

Abilities Requirement

 

Ability to clearly present issues, communicate the approach taken to analyze the issue, and clearly express the results to a wide variety of audiences. Strong attention to detail required. Ability to work well with others across various levels and areas within the organization. 

Commitment to Team Culture

 

The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.

 

Starting Salary: $85,841.60  - $109,449.60  

Pay rate will commensurate with experience

 

Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region. With a provider network of more than 6,000 and a team of more than 2,000 employees, IEHP provides quality, accessible healthcare services to more than 1.2 million members. And our mission and core values help guide us in the development of innovative programs and the creation of an award winning workplace. As the healthcare landscape is transformed, we’re ready to make a difference today and in the years to come. Join our Team and Make a Difference with us! IEHP offers a Competitive salary and a benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and retirement plan.

 


Nearest Major Market: Riverside
Nearest Secondary Market: Los Angeles