[Remote] Administrative Assistant Representative

Note: The job is a remote job and is open to candidates in USA. Tailored Management is seeking an Administrative Assistant Representative to support the Quality of Care team activities. The role involves managing quality of care cases, communicating with providers, and assisting nurses with documentation and record management.ResponsibilitiesUtilizing QNXT to ascertain if a provider is par vs. non-parCommunicating with the Grievance Administration Division (GAD) team to clarify complaints or obtain additional informationPosting cases to the QOC spreadsheet on the T: driveAssigning cases to the QOC nurses (once Triaged) in MHK Portlet – equitably according to work flowCreating case files on the T: driveRequesting medical records (up to 3 requests) and posting received records to case filesAssisting QOC nurses with completion of QOC resolution letters and mailing of resolution lettersMaintaining all QOC letter templates and job aids for the QOC teamInterfacing with providers and facilities in obtaining medical recordsUtilizing CCMS to obtain QOC case informationProvide weekly and monthly reports on QOC case referrals and CM assigned casesStrong attention to detail and work accuracyMaintain QOC email box for distribution of emails as appropriate, internal referral cases and collaboration with business partner on the exchange of information pertaining to case reviewsManage Conduent fax portlet for incoming faxes to QOC DepartmentNote take during Departmental meeting and distributing minutes as appropriateMaintain QOC Nurse work sheet and update as appropriate to align with changesAssists in the preparation, management and presentation of other Quality of Care reports as appropriateMaintains performance against established targetsPerforms other job-related duties as requiredSkillsThree plus years of quality review and improvement experience requiredTwo plus years of relevant experience within Quality Management and/or Grievance processesStrong attention to detail and work accuracyStrong knowledge of common patient disease processes and usual methods of treating themThorough knowledge of medical terminology and commonly used equipmentAbility to effectively evaluate medical records for appropriateness of careAbility to assess and judge the clinical performance of physicians and other health professionalsStrong analytical, assessment and problem-solving skillsStrong interpersonal skills, including the ability to establish and maintain effective working relationships with individuals at all levels both inside and outside the organizationFacilitates an atmosphere of collaboration and team workAbility to effectively manage both clinical and non-clinical staff in support of both individual staff and team successEffective oral and written communication skills, including the ability to effectively explain complex information and document according to standardsIntermediate skills in Word, PowerPoint, Excel, and Outlook with basic ability to enter data into and navigate through a databaseMaintains confidentiality of all sensitive documents, records, discussions and other information generated in connection with quality of care activitiesSelf-directed and able to work independently. Uses appropriate judgment to seek assistance and ask questionsKeeps QOC Manager updated on overall activities, issues identified, and actions to address issuesOperates with target dates and deadlines and is able to meet deadlines with successful outcomesAppropriately negotiates changes to target dates and holds staff accountable to target datesExperience with CMS, NCQA standards, HEDIS, CAHPS, HOS and quality management preferredKnowledge/experience in the Medicare/Medicaid industry preferredBenefitsHealth, Dental, VisionCompany OverviewTailored Management is a staffing and recruiting company that offers information technology staffing and recruitment services. It was founded in 2009, and is headquartered in Columbus, Ohio, USA, with a workforce of 501-1000 employees. Its website is http://tailoredmanagement.com.