Manager I-CAP Acupuncture (Remote)

American Specialty Health Incorporated is seeking a Manager I - CAP - Acupuncture to join our Clinical Quality Admin (CQA) department. This position will coordinate and support the processes within the Clinical Quality Administration (CQA) Department, including the performance of Clinical Corrective Action Plan (CAP) compliance reviews, presentations to the Practice Review Committee (PRC) of the CAP compliance reviews, and possible participation in the ASH clinical practitioner hearing process.

Salary Range

American Specialty Health complies with state and federal wage and hour laws and compensation depends upon candidate's qualifications, education, skill set, years of experience, and internal equity. $69,116.00 to $85,000.00 Full Time Annual Salary Range.

Remote Worker Considerations

Candidates who are selected for this position will be trained remotely and must be able to work from home in a designated work area with company-provided technology equipment. This remote/WFH position requires you have a stable connection to your Internet Service Provider with the ability to participate by video in online meetings over a reliable and consistent network (minimum internet download of 50 Mbps and 10 Mbps upload speed).

Remote Worker Considerations:

Candidates who are selected for this position will be trained remotely and must be able to work from home in a designated work area with company-provided technology equipment.

Responsibilities

• Assist in the management of CQA functions within the organization (as directed by department leadership).
• Assists in management and is accountable for all activities within assigned scope of authority. Ensures accuracy and productivity in project completion and works cooperatively with all internal and external contacts. Achieves and exceeds company standards in management of quality management tasks.
• Perform CAP compliance reviews with presentation of the reviews to the PRC.
• Assist with phone calls made to practitioners for CAP outreach/education and phone calls received from practitioners including but not limited to practitioner education, etc.
• Manages projects in support of department goals.
• Develop broader knowledge of NCQA and URAC accreditation requirements.
• Support Key Process Teams as required by department leadership.
• Support sales and marketing education and training programs related to chiropractic, acupuncture, and massage therapy as required by department leadership.
• Support Practitioner Contracting and Communications (PCC) through practitioner education and outreach efforts as required by department leadership.
• Serve as resource to directors, managers, and staff relating to compliance and/or procedural inquiries.
• Assist in program or process changes to Clinical Performance System (CPS), as assigned.
• Assist in review of Medical Necessity Review forms (MNR) as needed.
• Manage the accuracy and confidentiality of quality-related communication and minutes.
• Assist staff, as appropriate, in supporting the resolution of quality-of-care issues.
• Attend meetings with customers when requested by department leadership.
• Support the development and writing of QIA's and QI studies and presentation to appropriate committees for review and recommendations.
• Assist in development of annual QI evaluation, QI program and QI work plan.
• Support companywide education in CQI processes by participating with appropriate Key Process Teams as needed.

Qualifications

• College education with degree in Health Care field, health information management or equivalent preferred. If equivalent experience, high school diploma required.
• Valid active license in clinical specialty (e.g., DC, MD, LAC, PT, RN), required.
• Extensive knowledge and experience in the field of acupuncture, either currently licensed as an acupuncturist or having received extensive professional/clinical training in the field of acupuncture required.
• Minimum 3 years health care administration experience. Specific experience to include utilization management case review preferred.
• Experience in Quality Improvement data analysis preferred.
• Demonstrated writing proficiency required.
• Knowledge of health care and/or legal terminology preferred.
• Knowledge of ASH preferred.
• Great attention to detail is required in all functions of this position.
• Strong understanding of ICD-10, CPT and HCPCS coding.
• Demonstrated English writing proficiency required.
• Ability to determine the medical necessity of services based on data provided and ASH guidelines.
• Use of computer systems in business applications including, but not limited to, 10-key, Outlook, MS-WORD, IHIS, ASHCore, SharePoint, OneDrive and Microsoft Teams.

Core Competencies

• Demonstrated ability to interact in a positive, respectful manner and establish and maintain cooperative working relationships.
• Ability to display excellent customer service to meet the needs and expectations of both internal and external customers.
• Excellent listening and interpersonal communication skills to identify critical core competencies based on success factors and organizational
• Ability to effectively organize, prioritize, multi-task and manage time.
• Demonstrated accuracy and productivity in a changing environment with constant interruptions.
• Demonstrated ability to analyze information, problems, issues, situations and procedures to develop effective solutions.
• Ability to exercise strict confidentiality in all matters.

Mobility

Primarily sedentary, able to sit for prolonged periods. Able to travel by automobile and air.

Physical Requirements

Ability to speak, see and hear other personnel and/or objects. Ability to communicate both in verbal and written form. Ability to travel within the facility. Capable of using a telephone and computer keyboard. Ability to lift up to 10 lbs.

Environmental Conditions

Work-from-home (WFH) environment.

American Specialty Health is an Equal Opportunity/Affirmative Action Employer.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex including sexual orientation and gender identity, national origin, disability, protected Veteran Status, or any other characteristic protected by applicable federal, state, or local law.

Please view Equal Employment Opportunity Posters provided by OFCCP here.

If you are a qualified individual with a disability or a disabled veteran, you have the right to request an accommodation if you are unable or limited in your ability to use or access our career center as a result of your disability. To request an accommodation, contact our Human Resources Department at (800) 848-3555 x6702.

ASH will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the Company's legal duty to furnish information.
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