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CME Quality Assurance Coordinator

Wingspan Care Group

Shaker Heights, OH

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JOB DETAILS
SKILLS
Behavioral Health, Billing, Clinical Data, Communication Skills, Computer Software, Computer Systems, Data Collection, Healthcare Quality, Hospital, IP Multimedia System (IMS), Incident Management, Interpersonal Skills, Licensing, Medicaid, Medical Record System, Nonprofit, Onboarding, Operations Management, Operations Processes, Organizational Skills, Original Design Manufacturer (ODM), Presentation/Verbal Skills, Problem Solving Skills, Psychiatry and Mental Health, Quality Assurance, Quality Management, Regulations, Root Cause Analysis, Team Player, Time Management, Training/Teaching, Writing Skills
LOCATION
Shaker Heights, OH
POSTED
10 days ago
JOB SUMMARY: Reporting to the Executive Director, the Care Management Entity (CME) Quality Assurance Coordinator supports the secondary functions of the CME through the implementation, operation and management of a continuous quality improvement. The CME Quality Assurance Coordinator provides oversight of reporting for Aetna, Ohio Department of Medicaid (ODM), and the Center of Excellence (COE). Further, the CME Quality Assurance Coordinator supports the Director to ensure the division billing is completed accurately and meets required timelines.

ESSENTIAL DUTIES:
  1. Manage all Ohio Incident Management System (IMS) reporting, ensuring both timely submission and follow up. Review all submissions for accuracy and completion.
  2. Lead and oversee weekly capacity reporting to Aetna.
  3. Assist Director in coordinating internally and externally-provided training during the initial onboarding phase.
  4. Ensure clinical quality assessments directed by the COE which include, but are not limited to, Wrapstat and the Quality CANS Review Tool (QCRT) are completed and submitted on a monthly basis.
  5. Review and check monthly billing for complete and accurate billing of the CME activities.
  6. Act as a SmartChart Super User and SME for the CME. Support all new CME employees in learning the Agency Electronic Health Record (HER) system.
  7. Support the department as assigned during regulatory surveys and reviews.

OTHER DUTIES:
  1. Attend scheduled staff meetings, supervision, and on-going training.
  2. All required trainings, certifications and licensure must be kept current in accordance with applicable licensing and accreditation regulations and standards.
  3. Maintain high standards of ethical and professional conduct and adhere to Agency policies and procedures.
  4. Other duties as assigned by management.

QUALIFICATIONS:
  1. Education: Minimum of a Bachelor's Degree required.
  2. Licensure: N/A
  3. Competency/Skills:
  • Core Expertise: Possess skill, knowledge and abilities to perform the essential duties of their role; keeps knowledge up to date.
  • Independent Judgment: Demonstrate ability to perform job responsibilities with a high degree of initiative and independent judgment.
  • Cultural Competency: Demonstrate awareness, sensitivity and skills in working professionally with diverse individuals, groups and communities who represent various cultural and personal background and characteristics.
  • Interpersonal Communication: Communicate clearly using verbal, nonverbal, and written skills in a professional context; demonstrates clear understanding and use of professional language.
  • Professional & Ethical Conduct: Adhere to professional values such as honesty, personal responsibility, and accountability; Applies ethical concepts within scope of work and adheres to Agency policies and procedures.
  • Collaboration and Teamwork: Function effectively as a member of a professional team that includes employees, clients and family members.
  • Problem Solving & Decision Making: Recognize problems and responds appropriately; gathers information and sorts through it to identify and address root cause issues; makes timely decisions.
  • Service Orientation: Anticipate, recognize, and meet the needs of others, whether they are clients or not.
  • Technical Proficiency: Demonstrate competence in utilizing Agency computer systems and software as required to perform essential job functions.
  1. Experience: One year experience within medical or behavioral healthcare working with clinical data required.


Wingspan Care Group ("Wingspan") is the not-for-profit parent company of Applewood Centers, Inc., Bellefaire Jewish Children's Bureau, Bluestone Child & Adolescent Psychiatric Hospital, and Lifeworks. The mission of Wingspan is to provide organizational efficiencies at the operational, administrative, and fiscal levels for its subsidiary agencies so that they may focus on their respective missions. Wingspan is an Equal Opportunity Employer. Wingspan's policy is not to discriminate against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (40 and over), disability, military status, genetic information, or any other basis protected by applicable federal, state, or local laws. Wingspan also prohibits harassment of applicants or employees based on any of these protected categories.

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Wingspan Care Group

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