Quality and Utilization Management Specialist

 

What you will be doing:

The Quality and Utilization Management Specialist will be the owner of, and the primary individual responsible for interdepartmental coordination of monitoring and preparing submissions for initial and renewal of Utilization Review (UR) state licenses. This role will work closely with legal and other industry resources to conduct regulatory research for licensing and compliance and working collaboratively with internal/external stakeholders to communicate current and relevant information and requirements.

This position will also support the Sr. Director, Quality and Utilization Management in developing, implementing, monitoring and updating quality improvement and utilization management initiatives as well as policies, procedures and processes. Provides support for URAC and NCQA accreditation program standards and surveys, as well as any other accreditation program as adopted by the company. This role will require to stay apprised of regulatory changes, guidance, and industry developments relating to compliance, quality, and utilization management.

Key Responsibilities

• Documenting and tracking of all licensing requirements and application statuses.

• Work with internal departments and outside vendor(s), as applicable, for the timely completion and submission of licensing requirements.

• Coordinate with legal to monitor all state licensing requirements and implement changes as identified.

• Provide support in developing, implementing, monitoring and updating quality improvement and utilization management initiatives.

• Assist with implementing and maintaining RBUM policies, procedures and processes.

• Support quality improvement initiatives, including but not limited to: monitoring, auditing, and tracking of Utilization Management Program.

• Coordinate with other departments and assist as needed in performing/monitoring required UM internal audits.

• Collaborating with management to develop quality assurance plans, working with employees to implement the strategies, and reviewing documents for accuracy.

• Participates with URAC and NCQA accreditation program standards and surveys, as well as any other accreditation program as adopted by the company.    

• Assist with client audits and routine compliance tasks.

• Other responsibilities as assigned by Stanson management

​Required Qualifications

Work Experience:

Years of Applicable Experience - 2 or more years

Education:

High School Diploma or GED (Required)

 

Preferred Qualifications

Skills:

• Demonstrated ability to assume responsibility for daily activities and projects without direct supervision, including working within time frames to meet deadlines.

• Demonstrated experience with written communications and document preparation.

• Demonstrated organizational skills with strong attention to detail and quality.

Experience:

• Experience with policy review, report development/gathering to support NCQA/URAC accreditations. 

• Experience in organization, tracking, and trending of information

• Experience with Utilization Management Licenses (Nationwide)

• Experience with internal auditing

Education:

• Associate’s degree or equivalent experience in compliance

Location:

• Preferred location is east coast

Required Certifications/Licensing

•  CHC, preferred

 

Additional Job Requirements:

• Remain in a stationary position for prolonged periods of time 

• Be adaptive and change priorities quickly; meet deadlines 

• Attention to detail 

• Operate computer programs and software 

• Ability to communicate effectively with audiences in person and in electronic formats.   

• Day-to-day contact with others (co-workers and/or the public) 

• Making independent decisions 

• Ability to work in a collaborative business environment in close quarters with peers and varying interruptions 

 

Working Conditions: Remote

 

Travel Requirements: No travel required

 

Physical Demands: Sedentary: Exerting up to 10 pounds of force occasionally, and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves remaining stationary most of the time. Jobs are sedentary if movement is required only occasionally, and all other sedentary criteria are met.

 

Premier’s compensation philosophy is to ensure that compensation is reasonable, equitable, and competitive in order to attract and retain talented and highly skilled employees. Premier’s internal salary range for this role is $51,000 - $95,000. Final salary is dependent upon several market factors including, but not limited to, departmental budgets, internal equity, education, unique skills/experience, and geographic location. Premier utilizes a wide-range salary structure to allow base salary flexibility within our ranges.

Employees also receive access to the following benefits:

·       Health, dental, vision, life and disability insurance

·       401k retirement program

·       Paid time off

·       Participation in Premier’s employee incentive plans

·       Tuition reimbursement and professional development opportunities

Premier at a glance:

• Ranked #1 on Charlotte’s Healthiest Employers list for 2019, 2020 and 2022, and 49th Healthiest Employer in America (2022)
• ​Named one of the World’s Most Ethical Companies® by Ethisphere® Institute for the 13th year in a row
• The only company to be recognized by KLAS twice for Overall Healthcare Management Consulting
   

Employees receive:

• Perks and discounts
• Access to on-site and online exercise classes
• Paid time off to volunteer in their communities

Premier is looking for smart, agile individuals like you to help us transform the healthcare industry. Here you will find critical thinkers who have the freedom to make an impact. Colleagues who share your thirst to learn more and do things better. Teammates committed to improving the health of a nation. See why incredible challenges require incredible people.

Premier is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to unlawful discrimination because of their age, race, color, religion, national origin, ancestry, citizenship status, sex, sexual orientation, gender identity, gender expression, marital status, familial status, pregnancy status, genetic information, status as a victim of domestic violence, covered military or protected veteran status (e.g., status as a Vietnam Era veteran, disabled veteran, special disabled veteran, Armed Forces Serviced Medal veteran, recently separated veteran, or other protected veteran) disability, or any other applicable federal, state or local protected class, trait or status or that of persons with whom an applicant associates. We also consider qualified applicants with criminal histories, consistent with applicable federal, state and local law. In addition, as a federal contractor, Premier complies with government regulations, including affirmative action responsibilities, where they apply.

Premier also provides reasonable accommodations to qualified individuals with a disability or those who have a sincerely held religious belief. If you need assistance in the application process, please reply to [email protected] or contact Premier Recruiting at 704.816.5200.

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