Manager Of Operational Performance, Quality, And Compliance
Current- Responsible for leading the development and maintenance of quality programs to improve and monitor regulatory compliance and quality within several centralized clinical operations teams and delegated care coordination.
- Initiate and conduct various training sessions related to performance, compliance, and quality.
- Manage a robust and detailed denial notice quality program, resulting in consistent and compliant denial notices.
- Create job aids, resource materials, and case studies to educate team members and ensure ongoing regulatory compliance.
- Assisted with NCQA Utilization Management (UM) survey preparation, resulting in accreditation. Update the UM Program Description, UM Program Evaluation, and other documents required for continued compliance.
- Update UM member and provider letter templates (e.g., denial, approval, extension, withdrawal, and others) when required.