Manager, Medicare Clinical Ops. Audit/QA Job in Not Specified, Ohio US
Manager, Medicare Clinical Ops. Audit/QA
Manage all internal and external audit activities; Develops, leads and directs Quality Assurance Analysts and other staff supporting the audit/quality assurance process of clinical processes (including, but not limited to the coverage determination and appeals process); Responsible for being the strategic lead in identifying deficiencies and proposing opportunities for improvements; Manage the distribution of workflow within the CDA process; assist in the development and implementation of process improvements and corrective action plans to ensure regulatory compliance to improve customer and client service. Responsible for managing support to Compliance and other departments involved in audit. This includes monitoring and quality assurance as required; providing and maintaining audit responses for internal and external clients, providing proactive recommendations and ensuring the highest quality or most suitable audit/QA processes are utilized and enforced. This person will work closely with analysts, clinical operations support and compliance teams to ensure regulatory requirements are met. 1. Manage the development and execution of Internal Quality Assurance practices. Set direction for internal and external audit activities. Maintain and transfer current knowledge of regulations, standards and processes to ensure thorough understanding of the Medicare landscape 2. Analyze results of monitoring, investigate root cause and identify areas of improvement; develop and implement plan to correct areas of deficiency. 3. Full oversight and responsibility for audit response process; craft and lead response(s) to internal and external audit requests. 4. Manage project timelines for coordination and submission of summaries; provide detailed reports to reflect monitoring results and subsequent actions. 5. Administer training, coaching, mentoring, development and disciplinary actions as appropriate for staff 6. Strategic liaison between Medicare and the CVS Compliance/Audit Teams 7. Other duties as assigned BA/BS required. Audit, statistics, or other tech/science field preferred 6+ years managerial/audit experience preferred. PBM and Medicare experience preferred. MS Office, statistical methods, analytical skills with excellent oral, written and presentation skills. Ability to multi-task and time management while being detail oriented. If interested, please apply online at http://track.tmpservice.com/ApplyClick.aspx?id=1413771-2139-7418