Integrated Resources, Inc., is led by a seasoned team with combined decades in the industry. We deliver strategic workforce solutions that help you manage your talent and business more efficiently and effectively. Since launching in 1996, IRI has attracted, assembled and retained key employees who are experts in their fields. This has helped us expand into new sectors and steadily grow.

Job Summary:

This position is responsible for leading all aspects of quality management compliance for client. This includes compliance auditing and reporting, and complaint resolution.

Responsibilities:

• Directs staff to support quality improvement and initiatives specifically related to Quality Audit, State Complaints, Complaint Resolution, to ensure appropriate staffing and effective operation.

• Oversees Quality Management compliance and URAC/NCQA and NJ State EQRO (currently IPRO) and provides leadership to ensure attainment of high accreditation standards.

• Develops and implements strategies for quality improvement and initiatives.

• Responsible for assuring timely correction of deficiencies, identification of problem providers and promptly reports difficulties or lack of cooperation to the Director of Quality Management.

• Interfaces with other teams and plan areas to assure consistent application of policies and procedures and to facilitate inter-unit/department projects.

• Works with Utilization Management to develop related policies and procedures.

• Participates in special projects as assigned by the Director, Quality Management.

• Provide leadership and utilizes professional and communication skills to direct and motivate staff to ensure high quality outcomes.

• Represents the Plan with external customers, providers and external agencies and represents the unit on corporate issues and/or in the event of Director's absence.

• Manage, direct, and develop staff by providing feedback and coaching. Administer performance, and salary review for staff.

• Ensure staff meets all regulatory requirements and utilizes best practice methodology.

Knowledge:

• Requires working knowledge of NCQA accreditation standards.

• Requires thorough knowledge of managed care products and benefit contract agreements.

• Requires knowledge of HEDIS, CAHPS, and QAPI for CMS.

• Requires the ability to think analytically and to use logic in the solving problems.

• Must be proficient in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint & Outlook); Should be knowledgeable in the use of intranet and internet applications.

Skills and Abilities:

• Requires excellent verbal and communication skills.

• Requires strong project management skills.

• Requires strong organizational skills.

• Requires strong problem solving and decision making skills.

• Requires good analytical skills.

• Requires strong relationship building skills to work collaboratively across departments/divisions.

Education/Experience:

• Requires a Bachelor's degree from an accredited college or university.

• Requires five (5) years managed care experience.

• Requires a minimum of five (5) years quality management experience.

• Requires minimum of five (5) years management experience.

• Requires project management experience.

Additional licensing, certifications, registrations:

• Requires a Registered Nurses license in the State of New Jersey.

Thanks & Regards,

Nishit 

732-429-1639