Managed Care Quality Specialist

AgeSpan

Formerly Elder Services of the Merrimack Valley/North Shore

About Us: Since 1974 our agency has strived towards supporting an individual's desire to make their own decisions, secure their independence and remain living independently in the community. We are proud of our employees who make this possible every day. Our agency is a thought-leader, a nationally known generator of new ideas, because it welcomes creativity, your ideas. It is an outstanding place to work stimulating, friendly, collaborative. We offer competitive salaries, generous vacation time, and an excellent work/life balance. We value diversity and encourage career growth. If you have a passion for improving the lives of the elderly community and enjoy working in a diverse team driven by its mission, you've found the right place!

At AgeSpan, you'll find a work environment that combines:

• A refreshing culture that is supportive, collaborative, and encouraging of diverse perspectives and backgrounds.
• A focus on innovation with a team recognized for developing and implementing innovative programs and novel solutions.
• Encouragement of your development through opportunities to get involved, use your voice, and gain new knowledge and skills.
• A satisfying balance between your work and personal life, including a flexible workplace, generous paid time off, and wellness programs.

Depending on your role and your hours, we offer

• Flexible schedule and hybrid work opportunities
• Competitive salaries
• Healthcare (medical, dental)
• 403b Retirement Plan with agency match
• 20 Vacation Days, 12 Sick Days, and 12 Paid Holidays
• Social Work Licensing Program
• License Renewal Paid by agency for RN's and Social Workers
• And MORE!

Position Responsibilities: Under the direction of the Managed Care Program Manager, assist in the development and maintenance of quality assurance systems and processes related to the Managed Care Department. Track and measure compliance with ASAP and Managed Care standards, consistent with the goals, vision and values of AgeSpan. Work collaboratively with Managed Care Program Managers to implement QA expectations and to re-train staff if needed.

Essential Functions: (Core duties or tasks that are fundamental and not marginal to the performance of the job)

• Work in collaboration with Managed Care Program Managers to implement QA procedures and standards to measure and ensure care management quality related to Managed Care programs.
• Implement and utilize tools and reports to measure quality on an ongoing basis.
• Assume responsibility for review of Managed Care member cases and to collect statistical data to ensure best quality standards are being met.
• Assist with the QA portion of the Managed Care Department annual employee performance review process by tracking and reporting relevant audit results and conducting audits.
• Work with Managed Care Quality Training Specialist to help to identify department training needs based on data gathered from quality audits and case reviews.
• Meet with new staff and or ongoing staff to retrain on quality procedures and processes as directed by the Managed Care Program Managers.
• Participate in professional development activities in order to be up to date with new and established Quality Assurance methods, trends and measurement activities.
• Complete various short term assignments and/or reports at the discretion and need of the Managed Care Programs Managers.
• Other duties as assigned.

Qualifications: BA/BS in social work, human services, or related field with a minimum 2 years of Case Management experience required. An associate degree with a minimum of 2 years' experience in human services may be substituted for BA/BS. LSW or license eligible preferred. Required skills include excellent Quality Assurance ratings on past performance evaluations, strong attention to detail, strong organizational skills, ability to take initiative, excellent interpersonal skills with ability to effectively communicate on one-to-one level and with larger groups, ability to work independently or as part of a team, proficient in word processing, database entry, and e-mail applications.

Hours: 37.5 per week

AA/EOE

AgeSpan is strongly committed to fostering a professional environment that recognizes, respects, and encourages the unique contributions of a broad spectrum of qualified employees. It is important that our employees reflect the diverse communities we serve. We maintain a work atmosphere that allows people of varied backgrounds to grow professionally and contribute to our mission by promoting diversity, equity, inclusion, and work-life balance.