Quality Coordinator Clinics FT - Bravera Markets | Spring Hill, FL

us as you discover the meaning behind Caring. Connecting. Growing together. The Regulatory Adherence Utilization Management Sr. Clinical Quality RN is responsible for monitoring and reporting compliance issues, with Utilization Management (UM) organization determinations, both internal and external from vendors interfacing with health plans, and oversight of health plan delegated reports.

Monitoring includes ongoing audits, improvement actions and overall feedback on the process to ensure adherence by Utilization Management (UM), and Inpatient Case Managers to requirements pertaining to NCQA and CMS. This position requires a current unrestricted nursing license (i. e. RN) in the applicable

state, who is a subject matter expert and is able to provide innovative solutions to complex problems, oversees UM reporting functions, ensures accuracy through data validation and leads quality improvement initiatives for remediation.

Primary Responsibilities: Conducts audit reviews of Organization Determinations, Adverse Determinations and Notice of Medicare Non-Coverage documents (NOMNC) and Detailed Explanation of Non-Coverage (DENC) documents to assure accuracy and compliance with UM health plan, CMS, NCQA, URAC and Department of Insurance guidelines Utilizes audit tools to perform documentation audits on job functions within Utilization Management Performs regular audits to ensure

data entry accuracy Performs regular audits to ensure Compliance of required documentation Communicates regular audit results to management and interfaces with managers, staff and training to make recommendations on potential training needs or revision in daily operations Reports on departmental functions to include, data entry accuracy and monthly trends of internal audits Prepares monthly and/ or quarterly summary report compiling data for all markets Prepares monthly and/ or quarterly detailed and trending employee report Participates in the development, planning, and execution of auditing processes Fosters open communication with managers/directors by acting as a liaison between the Training Department(s), the Medical Management Department(s) and the Utilization Departments Identifies and communicates with appropriate departments, teams, and key leadership on internal audit results and/or deficiencies Identifies and communicates gaps between CMS requirements and internal documentation audits to appropriate departments, teams, and key leadership Manages and performs tasks related to annual audit review (or more frequent review as requested) for contracted Health Plans as well as pre-delegation review with potential Health Plans Prepares and audits files for submission as required Participates in Regulatory Adherence Utilization Management (RA UM) audits and assists business with supplying information as needed Guides and influences the audit process by ensuring that auditors adhere to the scope of the audit Follows up on action items and attempts to supply all needed information as needed Follows up on corrective action plans and improvement action plan ensuring timely closure Monitors data collection tools and ensures updates occur as regulatory and accreditation changes occur Provides direction and expertise on regulatory and accreditation standards to internal personnel Coordinates with RA UM Delegated partners to ensure adherence to all regulations, contractual agreements, CMS, NCQA, URAC, and Department of Insurance guidelines Performs audit reviews including annual audits to evaluate policies, CMS compliance and adherence to RA UM health plans with regular audits focusing on compliance with Organization Determination and Adverse Determination regulations Demonstrate understanding necessary to backss, review and apply criteria (e.

g. MCG guidelines, CMS criteria, medical policy, and health plan specific criteria.

)Apply knowledge of pharmacological and clinical treatment protocol to determine appropriateness shop audit reviews Prepares a summary report of each evaluation including any deficiencies and corrective action plans Provides regular follow-up with delegates for completion of corrective action plans and improvement action plans Identifies and communicates with appropriate departments, teams, and key leadership on internal audit results and/or deficiencies Provides all required Regulatory Adherence Utilization Management (RA UM) reports to health plan Validates accuracy of reports prior to submission Submits reports timely according to health plan requirements Analyze results, provide interpretation, and identify areas for improvement Interfaces with IT and provides direction regarding additional reports or changes to RA UM reports Ensure Compliance with Relevant Processes, Procedures, and Regulations Ensure compliance with accreditation requirements (e.

g. NCQA, CMS) and relevant health plan requirements Utilize evidence-based guidelines (e. g. medical necessity guidelines, practice standards, industry standards, best practices, and contractual requirements) to make clinical decisions, improve clinical outcomes and achieve business results Follow internal policies/procedures (e.

g. job aids, medical policy and benefit documents)Identifies and communicate gaps between CMS and NCQA requirements and internal documentation audits to appropriate departments, teams, and key leadership Recognize when additional regulations may apply, research, and collect additional data as needed to obtain relevant information Analyze results, provide interpretation, and identify areas for improvement Providing internal and external results compared with goals for annual program evaluations and presentation to the Medical Management and Utilization Management, and Clinical Education Departments Performs all other related duties as assigned This is an office-based position near IH 10 W.

The position is Hybrid and will require 3 days a week in-office. You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: Bachelor of Science in Nursing, Healthcare Administration or a related field Current unrestricted Registered Nurse (RN) with current license in Texas, or other participating states5+ years of progressively responsible healthcare experience to include experience in a managed care setting, and/or hospital settings, and/or physician practice setting3+ years of experience in managed care with at least two years of Utilization Management experience Knowledge and experience with CMS, URAC and NCQAKnowledge of Medicare and Medicaid benefit products including applicable state regulations Demonstrate knowledge of computer functionality navigation and proficiency with Microsoft Office applications required (e.

g. Windows, Microsoft Office applications including Microsoft Word and Microsoft Excel)Demonstrate knowledge of specific software applications associated with the job function (e. g. navigation of relevant computer applications or systems, intranet databases, records management or claims databases)Willing to occasionally travel in and/or out-of-town as deemed necessary Preferred Qualifications: Health Plan or MSO quality, audit or compliance experience Auditing, training or leadership experience Solid knowledge of Medicare and TDI regulatory standards Solid knowledge of process flow of UM including prior authorization and/or clinical appeals and grievance reviews Physical & Mental Requirements: Ability to lift up to 25 pounds Ability to sit for extended periods of time Ability to stand for extended periods of time Ability to use fine motor skills to operate office equipment and/or machinery Ability to receive and comprehend instructions verbally and/or in writing Ability to use logical reasoning for simple and complex problem solving Values Based Competencies Employee Integrity Value: Act Ethically Comply with Applicable Laws, Regulations and Policies Demonstrate Integrity Compassion Value: Focus on Customers Identify and Exceed Customer Expectations Improve the Customer Experience Relationships Value: Act as a Team Player Collaborate with Others Demonstrate Diversity Awareness Learn and Develop Relationships Value: Communicate Effectively Influence Others Listen Actively Speak and Write Clearly Innovation Value: Support Change and Innovation Contribute Innovative Ideas Work Effectively in a Changing Environment Performance Value: Make Fact-Based Decisions Apply Business Knowledge Use Sound Judgement Performance Value: Deliver Quality Results Drive for Results Manage Time Effectively Produce High-Quality Work At United Health Group, our mission is to help people live healthier lives and make the health system work better for everyone.

We believe everyone-of every race, gender, interactionuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

Diversity creates a healthier atmosphere: United Health Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, interaction, age, national origin, protected veteran status, disability status, interactionual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

United Health Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. For more details: jobs-search. org/administration_san-antonio-c427366/registered-nurse-rn-clinical-quality-analyst-hybrid-san-antonio-texas-san-antonio_i1959780736

understanding of webservices and web applications. Minimum of 2 years of experience testing webservices. Experience with QA automation tools preferably smartbear SOAP-UI/Ready API, Load UI, and selenium web Driver. Good understanding of groovy/java scripting and clear understanding of OOP.

Comfortable in creating and executing automated test scripts via Jenkins and directly via testing tool if needed. ·Experience with testrunner like Ready API runner, j Unit5, test NG or Cucumber. Good understanding of design patterns for test automation. Clear understanding of Maven or Gradle builder, working experience on creating and managing jobs in Jenkins. Experience with Power BI is preferred. Experience with clouding such as Azure testing is preferred. Interested candidates can send their updated resumes at xyz X@global- Job Posted by Applicant Pro

aviation needs through dependable, globally integrated services with trusted results. Established in 1976, our locations include: Calgary (HQ) and Vancouver in Canada, Great Falls and Jacksonville in the USA, Nairobi in Kenya, and N'Djamena in Chad.

Avmax offers the following capabilities: Aircraft Leasing, Airline Operations, Avionics, Component Repairs, Engineering, MRO, Paint and Spares. Avmax's engineering division is a Transport Canada authorized Design Approval Organization (DAO). Avmax's maintenance division is a Transport Canada authorized Maintenance Repair Organization (MRO). Why work at Avmax? Avmax has a diverse workforce with opportunity for growth and career advancements.

We offer competitive compensation and benefit packages, flexibility, work-life balance and a friendly working environment. We are proud of our work and commitment to create one of the leading workforce, products and services in the Aviation industry.

Reporting Structure The position reports directly to the Quality Control Manager. his position assures that inspections and maintenance is carried out to the highest degree of quality and safety. Inspection performance assures compliance with the customer requirements and their maintenance program requirements. The QC Inspector works in direct liaison with production and planning personnel in determining maintenance requirements, coordinating

maintenance, and inspection schedules and all modification changes required by a customer/operator.

Core Competencies Accountability Attention to detail Problem-solving Effective communication, both verbal and written Confidentiality Excellent investigation and critical-thinking ability Judgement Professionalism Organization and time management skills Key Performance Indicators / Duties & Responsibilities Act as an RII Inspector for an air carrier on a customer aircraft if approved. Attend training courses as directed by company management. Act as a receiving inspector for parts as required. Ensure work environment is safe and clean. Promote company values, vision, and mission.

Certify aircraft for return to service. Directly responsible to carry out inspections and buybacks of the work and technical records on Avmax and customer aircraft as assigned. Certify components repaired by Avmax utilizing FAA Form 8130-3 and Form 417 Component Tracking Tag as applicable. Qualifications Must have a FAA Airframe and Powerplant Certificate (A&P). Good knowledge of aviation regulations. Demonstrated ability to work well with other individuals throughout the organization. Possesses strong fundamental aircraft knowledge. Demonstrated capability and competency in field of expertise.

Bombardier CRJ 200/700/900 and Embraer EMB 135/145 experience preferred. Experience Minimum 3 years' experience in the field. Qualifications: Requirements include an A&P (Airframe and Powerplant) license, excellent oral and written communication skills, the ability to lift up to 50 lbs. NDT experience is preferred. Requirements also include experience with CRJ 200/700, Dash 8, BAE 146, and/or EMB 120/135/145. Company Regulatory Training Requirements - Training will be conducted online unless otherwise specified HR & IT Orientation (instructor-led) Safety Orientation (instructor-led) Occupational Health and Safety Safety Management System (SMS) General Procedures Manual (GPM) Maintenance Policy Manual (MPM) Human Factors WHMIS Training Requirements - Mandatory for all employees Respect in the Workplace Training Workplace Violence and Harassment Training Workplace Sensitivity Training Workplace Bullying Training for Employees - All Jurisdictions Human Resources Training Requirements - Mandatory for all supervisors with direct reports A Guide to Workplace Incident Investigations Duty of Persons Directing Work (Bill C-45) Management Development Program (instructor-led) Occupational Health and Safety Awareness Training for Supervisors in All Jurisdictions Progressive Discipline Supervisor 101 - Avmax Internal Training (instructor-led) NOTE: Most training modules will be assigned as part of the onboarding program and must be completed within the first 3 months of employment.

Please refer to your onboarding schedule for further details. Safety Training for Safety Committee Members - (Only Applicable to employees who will be part of the Safety Committee) A Guide to Workplace Incident Investigations Health and Safety Committee Training for Committee Members Elective Programs / Courses Elective programs and/or courses should meet at least one of the following criteria: Alignment with core competencies / KPI's, as outlined in the current position profile; Development of one's skillset for career progression.

Elective courses can be aligned with a performance development plan. To find out more information please contact your Human Resources Department. All elective programs and/or courses are subject to prior approval by the authorizing Manager. Our recruitment commitments: We thank all applicants for their interest; however, only those selected for an interview will be contacted.

Depending on qualifications, selected candidates may be offered a role at a more appropriate level. Avmax Group offers a competitive compensation package including an optimal benefits plan and retirement plan. Avmax Group Inc. is dedicated to and prides itself on being an EEO/AA We celebrate and welcome the diversity of all of our employees. Avmax Group Inc. has specific policies in place to prevent discrimination in our hiring practices on the basis of the protected groups. Avmax is a drug free work environment and participates in pre-employment and random alcohol and/or drug screening. 0 Job Posted by Applicant Pro

Quality Assurance (QA) Jobs encompass roles focused on ensuring that products or services meet established standards of quality, reliability, and performance. These positions typically involve identifying defects, designing test procedures, conducting tests, and making improvements. Key characteristics of QA jobs include attention to detail, a strong understanding of quality metrics, the ability to analyze data, and problem-solving skills. Individuals in QA roles work closely with development teams and are critical in maintaining customer satisfaction by preventing errors and enhancing the user experience.