Clinical Quality Assurance Coordinator - Supervisor (32482)

About the role

The Clinical Quality Assurance Coordinator Supervisor oversees the Quality Assurance Department and provides leadership and direction to ensure operations run efficiently and effectively. This is a fully remote role with a flexible schedule of Monday - Friday 8-5pm ET or 9-6pm ET.

Responsibilities

• Cook up and direct the QA department’s daily workflow to ensure all product lines are completed with the highest level of quality in the most effective and efficient manner possible.
• Prioritize and manage the daily workload and ensure the appropriate and equitable distribution of work is maintained in order to achieve goals.
• Monitor work product to ensure clear, concise, evidence-based rationales have been provided in support of all recommendations or determinations and that specific indicators and criteria in accordance with company policy and procedures have been achieved.
• Ensure department compliance of all federal ERISA and state mandates is adhered to at all times.
• Promote effective and efficient utilization of all clinical resources and make necessary recommendations for improvements to management as needed.
• Ensure all client relationships are maintained and all client specific requirements are met.
• Aid promptly in resolution of any physician and/or customer complaints or quality assurance issues.
• Delegate work as needed and provide backup to all departmental positions as required.
• Provide insight and direction to management on consultant quality, availability, and compliance with all company policies and procedures.
• Participate in the development and implementation of policies and procedures in order to promote and achieve the most efficient operation possible.
• Participate in various educational and/or training activities as required.
• Perform other duties as assigned.

Essential Supervisory Responsibilities

• Carry out all responsibilities in accordance with the company’s standards, policies, and all applicable employment laws.
• Manage and monitor workflow and provide support, training, and techniques to assist staff in achieving department daily/weekly/monthly goals and standards.
• Encourage positive morale, maintain harmony among staff, and resolve grievances when necessary.
• Oversee the completion and approval of employee timecards and coordinate overtime needs with management and staff as needed.
• In conjunction with management, create and implement plans to meet department’s goals and metrics based on workload and client needs.
• Communicate change effectively and support those affected by change.
• Supervise insubordinate staff when warranted and initiate coaching or corrective actions as required and/or directed by upper management.
• Evaluate staff needs and performance, provide periodic feedback to staff and report any performance concerns and/or recommendations for growth opportunities to management.
• Actively participate and successfully conduct annual performance evaluations.

Qualifications

• A high school diploma or equivalent required.
• A minimum of three years related experience; or equivalent combination of education and experience preferred.
• Knowledge of the insurance industry, preferably claims management relative to workers' compensation, no-fault, liability, and disability is preferred.
• Previous supervisory experience preferred.
• Must possess a working knowledge of medical legal aspects of medical records and health information principles and/or liability.
• Must possess complete knowledge of general computer, fax, copier, scanner, and telephone.
• Must be knowledgeable of multiple software programs, including but not limited to Microsoft Word, Excel, and the Internet.
• Must be a qualified typist with a minimum of 40 W.P.M.
• Must demonstrate exceptional communication skills.
• Must analyze problems involving multiple interrelated causes.
• Must gather information and apply complex concepts or methods to generate an effective solution.
• Must follow instructions and respond to upper management’s directions accurately.
• Must demonstrate accuracy, thoroughness, and responsibility for quality of work, and ability to take initiative to identify improvements.
• Must analyze and evaluate staff needs and performance, provide periodic feedback to staff and report any performance concerns and/or recommendations for growth opportunities to management.
• Must be able to manage and direct change, delays, or unexpected events appropriately.
• Must possess the ability to manage and direct change, delays, or unexpected events appropriately.
• Must be able to work independently, prioritize work activities and use time efficiently.
• Must be able to take independent actions and calculated risks when needed.
• Must use good judgment and include the appropriate people in the decision-making process.
• Must be able to maintain confidentiality.
• Must be able to demonstrate and promote a positive team-oriented environment.
• Must be able to stay focused and concentrate under normal or heavy distractions.
• Must be able to work well under pressure and/or stressful conditions.
• Must possess the ability to manage and direct change, delays, or unexpected events appropriately.
• Must be able to follow all company policies and procedures in effect at time of hire and as they may change or be added from time to date.

Benefits

MES Solutions offers a fast-paced team atmosphere with competitive benefits (medical, vision, dental), paid time off, and 401k. Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, pregnancy, genetic information, disability, status as a protected veteran, or any other protected category under applicable federal, state, and local laws. Equal Opportunity Employer - Minorities/Females/Disabled/Veterans. MES has been providing services nationally since 1978 in accordance with the industry's highest standards of operating excellence and regulatory compliance.