Quality Management Specialist (Remote)

Who We Are

Founded in 1983, the Medical Review Institute of America (MRIoA) is the market leader for technology-enabled utilization management and clinical medical review solutions. We have an outstanding reputation for excellence and achieve continual improvement.

At MRIoA, we believe our employees are the key to our success. Here, you are more than just a cog in the machine – you are a valued member of our team.

WE OFFER

• A competitive compensation package.
• Benefits include healthcare, vision and dental insurance, a generous 401k match, paid vacation, personal time, and holidays.
• Growth and training opportunities.
• A team atmosphere with fun events and prizes scheduled throughout the year.
  
  

Position Overview

As a Quality Management Specialist, you will partner with key members of leadership for the design and implementation of Quality Management procedures, ongoing improvement efforts, and other team projects with the aim of achieving organizational, accreditation, and regulatory requirements.

Roles:

• Review and analyze current processes related to the application and implementation of policies, procedures, and practices; provide leadership with recommendations for updates to comply with the current regulatory and accreditation requirements. Identify gaps in efficient process workflow and suggests steps for quality process improvement.
• Measure process, errors/ adverse events/near misses, satisfaction (of the population served), complaints, access, or outcome trends performed using valid and accurate measurement methods; analyze trends to determine if defined performance metrics are met.
• Based on measurement and analysis of trends, make recommendations to leadership and collaborate with business units to implement activities designed to improve or correct identified problems, including reduction of errors/adverse events/near misses, or meet acceptable levels of performance.
• Manage Quality Improvement Projects (QIPs) and present new ideas for QIPs based on review and analysis of audit results and metrics.
• Manage the creation, follow up, and completion of corrective action plan(s) (CAPs) and Service Level Agreements in coordination with the Compliance Manager, Quality and Accreditation Manager, and Operations leaders
• Serve as liaison between clients and MRIoA’s quality management department as needed
  
  

Major Responsibilities or Assigned Duties:

• Assist leadership in establishing and reporting quality metrics. Aid in design and execution of quality improvement initiatives.
• Assist with the preparation, revision, and implementation of quality management policies and procedures.
• Perform back-end internal audits to identify and resolve quality, workflow, and production issues and ensure that organizational, accreditation, and regulatory requirements are achieved. Document the results of all back-end audits, track and trend data over time.
• Address and discuss issues and proposed solutions with leadership and document activities.
• Work closely with all departments on complying with Quality Management requirements.
• Collect, prepare and analyze data for corrective action and process improvement; manage company CAPA projects and see them through to resolution.
• Take part in internal testing of software updates; collaborate with Information Technology to identify and correct issues.
• Investigate quality issues to identify root causes and ensure issues are addressed and resolved.
• Assist the Quality and Accreditation Manager with managing the company Quality Management System. Develop and implement new modules as needed based on organizational need. Maintain QMS functionality, assess the need for updates/improvements, and test and implement updates in collaboration with Quality and Accreditation Manager and IT teams. Provide training and technical assistance as requested to ensure that all staff are familiar with the QMS and its tools and features.
• Assist with the complaint process when requested. Perform back-end audits to ensure proper handling and classification of complaints; analyze complaint data, track and trend audit results to identify risk areas and improve processes.
• Manage, maintain, and collaborate with business units to implement Quality Improvement Projects (QIPs) and Corrective Action Plans.
• Evaluate and document the effectiveness of implemented activities in attainment of desired performance thresholds and performance standards in MRIoA’s UM Program Evaluation. Report findings and make recommendations to Executive leadership on program success; revise ineffective quality improvement activities as necessary.
• Communicate issues or concerns relating to internal or external quality matters to department leadership.
• Coordinate resolution of top-level issues and provide coaching to teams about Quality Management process.
• Complete and/or aids other internal or external audits as requested.
• Complete other duties as requested.
• Ensure client satisfaction/enhancement activities are completed, including (next 3 bullet points):
• Deliver accurate data/metrics to internal stakeholders and ensure consistent and accurate communication of metrics to clients, regulatory, and accreditation bodies;
• Track, monitor, and report client SLA metrics; manage remediation plans and CAPs for SLAs not met in accordance with client contractual requirements;
• Manage and support all other client CAPs and remediation plans.
  
  

Requirements:

Skills and Experience:

• Exceptional customer service skills
• Exceptional analytical and critical thinking skills
• Excellent oral and written communication skills and interpersonal skills
• Exceptional orientation to detail
• Excellent organizational skills
• Ability to work under pressure and meet deadlines while managing multiple high priorities and supporting a flexible schedule
• Working knowledge of managed care and utilization review accreditation standards, including URAC and NCQA, and multi-state regulatory requirements
• Personal computer literacy and competency in use of Microsoft Word, Microsoft Excel (intermediate skill), Power Point and PowerBI
• Ability to maintain a high level of objectivity and confidentiality
• Minimum of 2 years in a quality management role preferred
• Experience in quality improvement activities within a healthcare, health insurance and/or managed care organization preferred
• Experience in supplying small group and individual training preferred
• Experience in research beneficial and preferred
  
  

Education:

• High School Diploma
• Preference for a bachelor’s degree or equivalent experience
  
  

Work Environment:

Ability to sit at a desk, utilize a computer, telephone, and other basic office equipment is required. This role is designed to be a remote position (work-from-home).

Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.



This company is a drug-free workplace. All candidates are required to pass a Background Screen before beginning employment. All newly hired employees will take a Drug Screen, as well as agreeing to all necessary Compliance Regulations on their first day of employment.