ILL1041 - Quality Assurance Specialist (LHCP)
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This position is responsible for the development, documentation and delivery of all training curriculum supporting the enterprise's Long Term Care (LTC) Claims and Care Management functions. The incumbent coordinates and conducts training in both classroom and one-on-one settings, and continuously monitors training collateral to ensure it is current and comprehensive. In addition, this position provides support to the Clinical Services team of auditors to conduct department and enterprise level quality audits, ensuring enterprise Care Management staff abide by approved Practice Standards.
RESPONSIBILITIES
Provides training support to new and existing Care Management and Claims staff, assists with development and maintenance of training materials, ensuring they are compliant with internal guidelines as well as new and existing client directives. Receives input from Operations Management, but has ultimate accountability for the accuracy of all material.
1. Provides training support to new and existing Care Management and Claims staff, assists with development and maintenance of training materials, ensuring they are compliant with internal guidelines as well as new and existing client directives. Receives input from Operations Management, but has ultimate accountability for the accuracy of all material.
2. Conducts needs assessment on staff and training courses to identify system and work flow training needs.
3. Communicates effectively in writing and verbally with internal and external customers. Provides assistance with policy interpretation as needed.
4. Provides quality assurance reviews for care managers and care coordinators for all clients to ensure appropriate benefit determination decisions are made, appropriate benefit periods are established and appropriate care plans are written providing feedback to the individual in writing or verbally. Identifies and provides feedback on training needs, claims trends and areas for operational improvement. Reports findings monthly to regional operations management and enterprise senior management.
5. Keeps Account Management informed and involved as necessary, to ensure client-specific technical and procedural documentation is accurate.
6. Supports Operations management in implementation of new clients to ensure procedures are compliant with client policy and plan documents, intent and with approved Best Practice standards.
7. Represents the Care Management training area in providing feedback to clients, to business units and to Clinical Services.
Provides training support to new and existing Care Management and Claims staff, assists with development and maintenance of training materials, ensuring they are compliant with internal guidelines as well as new and existing client directives. Receives input from Operations Management, but has ultimate accountability for the accuracy of all material.
1. Provides training support to new and existing Care Management and Claims staff, assists with development and maintenance of training materials, ensuring they are compliant with internal guidelines as well as new and existing client directives. Receives input from Operations Management, but has ultimate accountability for the accuracy of all material.
2. Conducts needs assessment on staff and training courses to identify system and work flow training needs.
3. Communicates effectively in writing and verbally with internal and external customers. Provides assistance with policy interpretation as needed.
4. Provides quality assurance reviews for care managers and care coordinators for all clients to ensure appropriate benefit determination decisions are made, appropriate benefit periods are established and appropriate care plans are written providing feedback to the individual in writing or verbally. Identifies and provides feedback on training needs, claims trends and areas for operational improvement. Reports findings monthly to regional operations management and enterprise senior management.
5. Keeps Account Management informed and involved as necessary, to ensure client-specific technical and procedural documentation is accurate.
6. Supports Operations management in implementation of new clients to ensure procedures are compliant with client policy and plan documents, intent and with approved Best Practice standards.
7. Represents the Care Management training area in providing feedback to clients, to business units and to Clinical Services.