Prime Care Coordination
  • Webster, NY, USA
  • Full Time

Summary:

The Quality Management Associate is responsible for ensuring services provided meet the established standards of quality in the domains of CCO/HH Care Coordination, customer satisfaction, and policy and procedure development. This role supports the operationalization and success of Prime Care Coordination's wholistic Quality Management Program.

 

 

Essential Job Functions

  • Assist with drafting and maintaining policies, procedures, and standard operating procedures related to quality and compliance.
  • Conduct and document internal audits and other quality improvement activities.
  • Evaluate audit findings and implement appropriate corrective actions.
  • Assist with monitoring risk management activities.
  • Assist with developing, maintaining, and distributing reports on quality to include audit findings and analysis of trends, patterns, and potential quality improvement opportunities.
  • Assist with devising sampling procedures and directions for recording and reporting quality data.
  • Assist with the development, audit, and reporting of the Quality Management Program and all of its components.
  • Assist with investigating customer complaints and non-conformance issues.
  • Assist with supporting on-site audits conducted by external providers.
  • Assist with collecting, compiling, and analyzing statistical quality data to identify areas for improvement in the quality system.
  • Support in developing, recommending and monitoring corrective and preventive actions.
  • Identify training needs and organize training interventions to meet quality standards.
  • Interpret and implement quality improvement standards and procedures.
  • Assist with evaluating adequacy of quality improvement standards.
  • Assist with maintaining record management system and quality department tracking of HIPAA Violations, customer complaints,
  • Ensure compliance with all federal/state laws and regulations, including affirmative action plan compliance.
  • Perform any other related duties as required by supervisor.

 

 

Knowledge, Skills, and Abilities

  • Knowledge of OPWDD and/or DOH regulations, programs, and service delivery systems including Medicaid Service Coordination, Care Coordination, Managed Care, Health Home Care Management and/or services for people with intellectual and developmental disabilities
  • Knowledge of audit, policy / procedures, quality assurance regulations.
  • Must be able to multi-task, establish priorities, and meet deadlines.
  • Must demonstrate attention to detail, planning and organizational skills.
  • Ability to work in a collaborative environment, work independently, and motivate others.
  • Ability to communicate effectively, both orally and in writing.
  • Ability to act quickly, assess, and act appropriately in crisis situations
  • Proficient with technology and understanding of health records
  • Data collection, management and analysis skills required
  • Maintain appropriate confidentiality and discretion at all times.

 

Education and Experience:

  • Bachelor's Degree in Healthcare, Business, Human Services Administration, or related field.
  • Minimum 2 years of experience within a health care or human services setting.
  • Possession of valid, unrestricted NYS driver's license required

 

All experience and education requirements, except when required by federal, state, or local laws or requirements, may be waived at the discretion of management with the approval of the Executive Director, in collaboration with Human Resources.

 

Physical Requirements/Working Conditions:

  • Ability to sit continuously.
  • Ability to reach above shoulder level.
  • Ability to turn/twist upper body.
  • Ability to use hand for repetitive action and fine manipulating for the purpose of keyboarding.
  • Must be able to travel throughout covered territories in Upstate NY as needed.

 

* Reasonable accommodations may be made to the extent required under applicable law to enable individuals with disabilities to perform the essential functions of this position.

 

Corporate Qualifications/Expectations:

  • Adhere to all Prime Care Coordination policies and procedures.
  • Adhere to the Agency Mission, Vision, Shared Values, and Customer Service Standards.
  • Attend mandatory education and training modules as scheduled; obtain and maintain required certifications/training by State regulations and PCC policy.
  • Act as a professional representative of PCC in regard to appearance, behavior, temperament, communication, language, and dress.
Prime Care Coordination
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