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CareOregon Inc. Quality Assurance and Compliance Manager in Seattle, Washington

Career Opportunities: Quality Assurance and Compliance Manager (24307) Requisition ID 24307 - Posted 06/04/2024 - CareOregon - Full Time - Permanent - Portland - Multi Location (7) Job Description Print Preview Job Title Quality Assurance and Compliance Manager Exemption Status Exempt Department Transportation Manager Title Director of Transportation Direct Reports Quality Assurance and Compliance Specialist, Grievance System Specialist Requisition # 24307 Pay & Benefits Estimated hiring range $96,950 - $117,315, 5% bonus target, full benefits. Posting Notes This is a Hybrid role, traveling within Oregon - to any of our 3 sites; Downtown Portland, Medford & the Oregon Coast at least 1x/month. Job Summary This position is responsible for quality assurance operational activities for Transportation services covered under Medicaid and Medicare lines of business, including appeals and grievances, as well as data reporting. This includes Non-Emergent Medical Transportation benefit administration as well as quality assurance for transportation services for social health services and programs supplementing covered benefit programs. This position manages non-clinical teams. Additionally, the Quality Assurance & Compliance Manager staffs NEMT Quality Assurance workgroups, participates in Oregon Health Authority and CO Quality Committees and assists in plan-wide regulatory activities. Essential Responsibilities Operations and Planning Develop and oversee implementation of policies and procedures related to responsible areas to meet Medicaid and Medicare contracting requirements and organizational needs. Collaborate with other members of the Transportation team to provide content updates or review other policies as needed. Assist the Director and collaborate in partnership with the Transportation Manager in the development of short and long-term quality planning. Guide appeals and grievances work across Transportation team and subcontracted partners and vendors. Manage regulatory functions of the department. Create and assist in maintaining evaluation tools. Review data and information to identify improvement opportunities, guide staff in the implementation of subcontractor and program improvements. Keep abreast of standards for health plan quality operations related to responsible areas and develop plans to operationalize. Keep abreast of all Medicare/Medicaid/NCQA regulatory expectations and inform staff and stakeholders of those changes. Contribute to and/or recommend the creation of subcontractor performance improvement or corrective action plans as needed related to issues identified with contract performance. Appeals and Grievances Provide technical leadership for appeals and grievances. Oversee department and subcontractor compliance of regulatory timelines for grievance and appeal resolution. Provide direction for Transportation team technical assistance to ensure all Medicare/Medicaid/NCQA regulatory expectations are adequately integrated into subcontracted partners and vendors. Provide guidance to the Transportation team in the development of processes and improvements. Cross Functional Collaboration Work collaboratively with other relevant CareOregon departments. Participate in workgroups/ meetings related to regulatory expectations. Work with Information Systems on reporting requirements. Committee Leadership and Participation Staff the NEMT Quality Assurance workgroups; participate in Oregon Health Authority and CO Quality Commi