What are the responsibilities and job description for the Healthcare Operations Quality Assurance (Hybrid in Rhode Island) position at Gainwell Technologies LLC?
Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development.
Summary
Under minimal supervision, performs routine to complex tasks that are related to various Medicaid related operations and policies. Continually monitors, assesses, and recommends improvements to Gainwell operations to ensure compliance with multi layered and dynamic regulations and policies. Monitors quality metrics and service level performance metrics to ensure efficient and effective workflow practices. Assist business function managers and leaders in monitoring the performance of duties to address quality issues. Prepares and distributes monthly leadership presentation materials with our client. Manage distribution and retention of client ad hoc requests.
Applies knowledge of established policies and procedures to research and resolve issues and ensure an individual case or complete process is compliant. Exercise independent judgment within defined practices and procedures to determine appropriate action. Evaluates unique circumstances and makes recommendations.
Facilitator for various audits including but not limited to: annual independent third-party audit of all operational practices; bi-annual PERM (federal CMS) audit of system and business processes; annual false claims act compliance audit; other periodic internal and external quality audits
Perform other duties as assigned and the business needs require. Involved in training of peers and will take the lead in areas of expertise. Will frequently work with Operations Management on special project or assignment that could include independent research and assessment of certain operations or processes with results documented in a briefing to management.
Your role in our mission
- Excellent oral and written communication skills
- Must demonstrate strong analytical skills.
- Self motivated with excellent time management and organizational skills, ability to work independently as well as part of a team
- Ability to effectively prioritize and handle multiple tasks and work under aggressive time constraints
- Excellent problem solving and decision-making skills
- Experience with Microsoft Office, Word, PowerPoint, Excel.
What we're looking for
- Bachelor’s degree and work experience in healthcare or insurance. Project Management experience helpful.
What you should expect in this role
- Hybrid, Rhode Island.
- Candidate will be required to attend in person meetings and work from the office as needed. Training may included additional time in-office.
#LI-HYBRID #LI-JW1
The pay range for this position is $50,400.00 - $72,000.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.
We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.
Gainwell Technologies is committed to a diverse, equitable, and inclusive workplace. We are proud to be an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. We celebrate diversity and are dedicated to creating an inclusive environment for all employees.
Salary : $50,400 - $72,000
