RN Manager of Quality Management - MLTC (Patchogue)

Compensation

: $83,450.00 - $117,470.00 /year *

Employment Type

: Full-Time

Industry

: Healthcare - Nursing



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RN Manager of Quality ManagementManaged Long-Term Care
Bronx, NY (near Marble Hill)

Manager of Quality Management Job Summary:
  • The Manager of Quality Management (QM) will be responsible for the development, implementation, coordination, maintenance, and oversight of the Quality, Compliance, and Regulatory Oversight staff.
  • This includes responsibility for the following:
    • focused studies to include access and member and provider satisfaction
    • oversight of the grievance and appeal process
    • audits to include pre-delegation, annual, follow up and focused
    • new employee compliance pre-screening and annual oversight
    • Health Plan reporting
    • oversight of compliance and regulatory requirements
  • The Manager of Quality will ensure that the functional responsibilities of quality management are conducted in a timely and efficient manner, performed in accordance with policies and procedures, within established fiscal parameters, in consideration of contracted health plan requirements, NCQA and URAC standards, and in compliance with applicable federal and state regulations.
Manager of Quality Management Background:
  • Requires Registered Nurse (R.N.) license.
  • Bachelor of Science in Nursing (BSN) or healthcare related preferred.
  • Around 2-3 years of acute care clinical nursing experience.
  • At least 2-3 years of Quality Management experience in a Managed Care Organization (Health Plan/HMO/MSO/TPA/IPA/etc).
  • At least 1-year previous management experience, in roles of increasing responsibility.
  • Ability to perform statistical/quantitative analysis required.
  • Experience processing Medicare and Medicaid appeals is required.
  • Strong computer proficiency (MS Office) and typing skills are necessary.
  • Skilled in influencing, leading and directing individuals in multiple functional areas.
  • Able to transform assignments from high-level objectives into independently established detailed goals.
  • Excellent verbal and written communication skills, as well as exceptional critical thinking skills.
#CLINICAL
#CARE1

Associated topics: ccu, coronary, hospice, intensive care, intensive care unit, maternal, nurse, nurse clinical, nurse rn, psychatric * The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.

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