Dec 15, 2019
WellCare Health Plans At WellCare, we are a passionate team with a strong mission and a focused purpose: to serve our members and communities in which they live while helping them live better, healthier lives. Our culture is one of empowerment, teamwork and commitment as we all work together to deliver cost-effective solutions that create positive outcomes for our members. Join us a career that inspires passion and purpose across all levels and disciplines within our award-winning organization. Provides support and project coordination for the field quality improvement team. Responsibilities include establishing working relations with both corporate partners and field Quality Improvement (QI) staff as well as Medical Directors across all Medicare markets. Reports to: Manager, QI Department: Health Services Location: Brentwood, TN 37027 Essential Functions: Provides support for the field Quality Improvement team across 12 Medicare states with potential for increased coverage as the line of business expands. Completes special projects or assignments as needed to meet initiatives and/or objectives of department. Assists and coordinates QI projects as needed. Maintains all department files in an organized, accurate manner. Assists with preparations for meetings by typing agendas, attachments and minutes; develops and revises PowerPoint presentations; maintains participant rosters; distributes documents via SharePoint, creates hard copy binder for committee chair and file room. Required to travel to corporate office for Quality Improvement committee meetings and other Medicare related meetings as deemed necessary. Maintains supply levels, equipment maintenance, communications and records. Maintains and secures files of QI activities. Directs communication to the appropriate staff. Responsible for managing the non-clinical portion of Quality of Care Issues (PQOCS); tracking/trending database, reports issues as directed to the credentialing department, obtains medical records, maintains PHI as per policy, tracks correspondence to/from providers. Responsible for managing the Medicare ambulatory medical record review process; maintains database of providers review, data enters outcome of review, and tracks correspondence related to Corrective Action Plans (CAPs). Other duties: ability to adapt to changes in policies/procedures and circumstances, learn new techniques, and accept additional responsibilities as assigned. Education: High school diploma required; college degree, preferably in a health related field, preferred. Experience: 3-5 years experience in a managed care health services environment. Knowledge of medical terminology and experience in data collection and data entry required. Understanding of data analysis and continuous quality improvement process preferred. Understanding/application of project management principles preferred. Licenses/Certifications: Special Skills (e.g. 2nd language): Excellent communication skills requiredAbility to communicate effectively with people at all levelsAbility to arrange their own work dayAbility to multitask in a fast paced environment Technical Skills/Requirements: Proficient in Microsoft Office including Word, Excel, Access, PowerPoint and Outlook About us Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses primarily on providing government-sponsored managed care services to families, children, seniors and individuals with complex medical needs primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, as well as individuals in the Health Insurance Marketplace. WellCare serves approximately 5.5 million members nationwide as of September 30, 2018. WellCare is a Fortune 500 company that employs nearly 12,000 associates across the country and was ranked a "World's Most Admired Company" in 2018 by Fortune magazine. For more information about WellCare, please visit the company's website at www.wellcare.com. EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.
Professional Diversity Network Brentwood, TN, USA Full-Time