Description
About Our Company
Gateway Health Plan® is a managed health care delivery system providing services to eligible medical assistance recipients. Gateway was formed in 1992 and is among the highest rated Medicaid health plans in the country. In 2006, Gateway launched a Medicare-approved Special Needs Plan for individuals who are eligible for Medicare and Medicaid and live within Gateway's service area.
Job Responsibilities Summary
Conducting medical record reviews, including audits for compliance with medical record standards, those related to any clinical studies including HEDIS and EQRO activities, and evaluation of quality of care concerns. Assisting in the coordination and implementation of the Quality Improvement Program and initiatives. Assisting in the preparation of any internal auditing, external accreditation survey or external state or federal regulatory compliance audit reviews, including document preparation and analysis for compliance. Development of clinical and preventive guidelines and studies, analysis of data and associated barriers and opportunities and coordination with internal and external customers to develop effective action plans based on findings. Coordination and collaboration with other Gateway departments, committees and physician work groups for activities related to assigned quality improvement activities. Auditing of processes performed by other Gateway departments and delegates per accrediting, governmental and regulatory requirements.
Required Qualifications
A Nursing or Diploma. Three (3) years of nursing experience with Quality Improvement or Utilization Management in a managed care health plan environment. Pennsylvania RN License.
Preferred Qualifications
Bachelor's degree in Nursing. Managed care health plan experience in Medicaid / Medicare. Knowledge of NCQA Standards. Strong analytical and problem solving skills with the ability to understand and interpret data. Proficiency using Microsoft Outlook, Word and Excel. Basic skills using Microsoft PowerPoint, Access and Visio.
Details:
Job Id:
58390
Annual Salary:
Position Type:
Education Level:
No Selection
Experience Level:
No selection
Posted:
9/6/2009 9:34:22 PM
Map
Careers & Community for Talented People with Disabilities