Quality Control Manager - Hybrid
Company: Tenet Healthcare
Location: Los Angeles
Posted on: November 19, 2023
As a part of the Tenet and Catholic Health Initiatives family,
Conifer Health brings 30 years of healthcare industry expertise to
clients in more than 135 local regions nationwide. We help our
clients strengthen their financial and clinical performance, serve
their communities and succeed at the business of healthcare.
Conifer Health helps organizations transition from volume to
value-based care, enhance the consumer and patient healthcare
experience and improve quality, cost and access to healthcare. Are
you ready to be part of our solutions? Welcome to the company that
gives you the resources and incentives to redefine healthcare
services, with a competitive benefits package and leadership to
take your career to the next step! JOB SUMMARY The role of the
Quality Control Manager is to provide oversight, daily
administrative management, and direct supervision of the Quality
control department. ESSENTIAL DUTIES AND RESPONSIBILITIES Include
the following. Others may be assigned.
- Manages the claims quality auditors and daily activities of
quality claims audit function. Reviews and tracks claims quality
audit reports and measures performance of auditors. Provides
assistance in developing claims audit policies and procedures. May
provide coaching in complex claims audit. Manages subordinate staff
in the day-to-day performance of their jobs. Ensures that
project/department milestones/goals are met. Has full authority for
personnel actions. Extensive knowledge of department
- Responsible for insuring client deliverables are met related to
the quality/compliance standards per current contract terms or
SLAs. This may be accomplished by, but not limited to the
- Coordinating daily workflow of auditing team to insure timely
auditing of staff accounts
- Distributing workload amongst auditors by allocating
assignments according to client needs
- Directing work priorities of direct reports and/or support
staff to insure timely processing of claims and or project
- Provides input to strategic decisions that affect the
functional area of responsibility such as
- Claims department, Compliance and Quality Control
- Develops a QC Plan that includes methods to measure, track,
analyze, report performance trends, root cause analysis of
deficiencies, implement corrective actions, and provide follow
- Proactively identify opportunities for improvement to processes
and scripts, responsible for reporting and documenting problems,
concerns or any issues identified during the review process to
Operations Excellence Committee and/or other Committees.
- Audits system configuration for new client implementation and
provider or Health Plan contracts and amendments.
- Various administrative functions associated with the above
duties include but are not limited to budget development and
monitoring, performance evaluations, team meetings and huddles,
interviewing/hiring new applicants, action plan development,
corrective action, scheduling, coordinating internal and external
quality reviews. KNOWLEDGE, SKILLS, ABILITIES To perform this job
successfully, an individual must be able to perform each essential
duty satisfactorily. The requirements listed below are
representative of the knowledge, skill and/or ability required.
Reasonable accommodations may be made to enable individuals with
disabilities to perform the essential functions.
- Strong knowledge and understanding of Managed Healthcare.
- Excellent communication skills, written and verbal.
- Must be well versed in reading Health Plan DOFRs and understand
all types of fee schedules, including risk pools.
- Excellent knowledge of CPT, RBRVS, DRG, HCPCS and ICD-9 coding
- Software: Microsoft Office, EZ-Cap, McKesson Claim Check,
Redbook, DRG Pricing Software
- Skilled in performing quality assessment/analysis
- Skilled in formulating or writing scripts
- Ability to apply common sense understanding to carry out
instructions furnished in written, oral or diagram form. Ability to
deal with problems involving several concrete variables in
- Must have strong interpersonal, written and verbal
communication skills and management experience.
- Ability to think/work independently yet interconnect with the
- Advance problem-solving skills
- Great attention to detail is crucial to this position Conifer
requires its candidates, as applicable and as permitted by law, to
obtain and provide confirmation of all required vaccinations and
screenings prior to the start of employment. This may include, but
is not limited to, the COVID-19 vaccination, influenza vaccination,
and/or any future required vaccines and screenings. EDUCATION /
EXPERIENCE Include minimum education, technical training, and/or
experience preferred to perform the job.
- Bachelor's degree or equivalent work experience required
- High school diploma or equivalent required
- 5 years or more experience processing managed health care
- 5 years or more experience as Quality Control Sr. or Lead
- Ability to manage all aspects of a team of on-site, remote
- Must possess extensive knowledge of different payment
methodologies, compliance guidelines REQUIRED
CERTIFICATIONS/LICENSURE Include minimum certification required to
perform the job.
- No certificate required PHYSICAL DEMANDS The physical demands
described here are representative of those that must be met by an
employee to successfully perform the essential functions of this
job. Reasonable accommodations may be made to enable individuals
with disabilities to perform the essential functions.
- Must be able to work in sitting position, use computer and
answer telephone WORK ENVIRONMENT The work environment
characteristics described here are representative of those an
employee encounters while performing the essential functions of
this job. Reasonable accommodations may be made to enable
individuals with disabilities to perform the essential functions.
- Office Work Environment TRAVEL
- Some travel may be required Compensation and Benefit
- Pay: $72,509-$108,763 annually. Compensation depends on
location, qualifications, and experience.
- Management level positions may be eligible for sign-on and
relocation bonuses. Benefits Conifer offers the following benefits,
subject to employment status:
- Medical, dental, vision, disability, life, and business travel
- Paid time off (vacation & sick leave) - min of 12 days per
year, accrued accrue at a rate of approximately 1.84 hours per 40
- 401k with up to 6% employer match
- 10 paid holidays per year
- Health savings accounts, healthcare & dependent flexible
- Employee Assistance program, Employe discount program
- Voluntary benefits include pet insurance, legal insurance,
accident and critical illness insurance, long term care, elder &
childcare, AD&D, auto & home insurance.
- For Colorado employees, Conifer offers paid leave in accordance
with Colorado's Healthy Families and Workplaces Act. 2305018808
Keywords: Tenet Healthcare, Los Angeles , Quality Control Manager - Hybrid, Executive , Los Angeles, California
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