Optum Quality Audit Jobs (NOW HIRING)

AgeSpanAbout Us: Since 1974 our agency has strived towards supporting an individual's desire to make their own decisions, secure their independence and remain living independently in the community. We are proud of our employees who make this possible every day. Our agency is a thought-leader, a nationally known generator of new ideas, because it welcomes creativity, your ideas. It is an outstanding place to work stimulating, friendly, collaborative. We offer competitive salaries, generous vacation time, and an excellent work/life balance. We value diversity and encourage career growth. If you have a passion for improving the lives of the elderly community and enjoy working in a diverse team driven by its mission, you've found the right place!At AgeSpan, you'll find a work environment that combines:A refreshing culture that is supportive, collaborative, and encouraging of diverse perspectives and backgrounds.A focus on innovation with a team recognized for developing and implementing innovative programs and novel solutions.Encouragement of your development through opportunities to get involved, use your voice, and gain new knowledge and skills.A satisfying balance between your work and personal life, including a flexible workplace, generous paid time off, and wellness programs.Depending on your role and your hours, we offerFlexible schedule and hybrid work opportunities Competitive salariesHealthcare (medical, dental)403b Retirement Plan with agency match20 Vacation Days, 12 Sick Days, and 12 Paid Holidays Social Work Licensing ProgramLicense Renewal Paid by agency for RN's and Social WorkersAnd MORE!Position Responsibilities: Quality Assurance: Assist in the development and maintenance of quality assurance systems and processes related to PCA Department functions. Track and measure PCA compliance with MassHealth standards and PCA regulations, consistent with the goals, vision and values of Agespan. Assist in the development of critical and analytical models to assess and improve customer satisfaction with PCA services. Work collaboratively with PCA Manager to develop training materials for staff, participate in the onboarding and orientation of new staff, and to lead re-trainings on an ongoing basis. Works as a member of the PCA team in cooperation with the PCA Program Manager to ensure smooth operations of the PCA Program and compliance with all EOHHS requirements.QA Essential Functions: (Core duties that are fundamental and not marginal to the performance of the job):Work with the PCA Program Leadership to create and implement QA procedures and standards to measure and ensure skills training quality related to PCA program in accordance with standards for PCA set forth by MassHealth and AgeSpan.Assist Program Managers with Quality Assurance measures related to EOHHS PCA regulations by completion of newly opened and routine case reviews in cooperation with the Quality Assurance RN and Program Manager. Help ensure needed follow up and collect statistical data as required.Act as liaison between AgeSpan and the MassHealth's third party administrator OPTUM. Ensure timely and accurate follow-up to all PAU requests by AgeSpan staff. Assist Program Managers in ensuring AgeSpan's compliance with PAU submission requirements through Quality Assurance measures.Assist Program Managers with compiling monthly MassHealth to SCO transfers.Perform the QA portion of the PCA annual employee performance review process by tracking and reporting relevant audit results and conducting audits as assigned.Monitor tools and reports to measure quality including compliance measurement reports and pre and post assessment systems for the PCA and Managed Care/PCA programs.Assist Program Managers with daily MassHealth batch eligibility verification and suspension reports and ensure timely follow-up by program staff of all requests for suspension and resumptions due to loss of MassHealth.Assist with routine monthly billing reports by ensuring timely follow-up by program staff of all requests from Manager related to billing, submitting timely and accurate billing data to AgeSpan's fiscal department and collaborating with the Fiscal Department to ensure PCA quality standards are met.Assist with onboarding new staff and assume responsibility for essential trainings during orientation.Assist PCA Program Leadership with implementation, maintenance, and oversight of standard operating procedures for all Program staff. Collaborate to maintain the PCA Procedure manual and all in-house and public-facing materials to ensure accurate and organized information.Help to identify PCA department needs for training and education based on data gathered from quality audits and case reviews. Provide education and coaching to new and experienced PCA Skills Trainers and Administrative staff to improve processes or address performance issues according to established standards and systems.Participate in any identified peer groups and Mass Health directed meetings, trainings, and regulatory activities for purposes of meeting quality assurance requirements of Mass Health as required.Participate in professional development activities in order to be up to date with new and established Quality Assurance methods, trends and measurement activities.Other duties as assigned.Qualifications: BA/BS in social work, human services or related field preferred. A minimum of 2 years Case Management or PCA Skills Trainer experience required. An Associates Degree with a minimum of 5 years Case Management or PCA Skills Trainer experience may be substituted for BA/BS. LSW or license eligible preferred. Required skills include excellent Quality Assurance ratings on past performance evaluations, strong detail orientation, excellent documentation skills, excellent interpersonal and communication skills with ability to effectively communicate on one-to-one level and with larger groups, ability to work independently or as part of a team, proficient in word processing, database entry, and e-mail applications.At AgeSpan, we carefully consider a wide range of factors when determining rate of pay. Actual rate of pay depends on factors including but not limited to internal equity, experience, and qualifications. The pay range for this position is $30.00 - $32.00/hour.Hours: 37.5 hoursOur Commitment to Diversity and InclusionAgeSpan is strongly committed to fostering a professional environment that recognizes, respects, and encourages the unique contributions of a broad spectrum of qualified employees. It is important that our employees reflect the diverse communities we serve. We maintain a work atmosphere that allows people of varied backgrounds to grow professionally and contribute to our mission by promoting diversity, equity, inclusion, and work-life balance.
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