Senior Quality Care Specialist

What will your job look like?

The Senior Quality of Care Specialist acts as a resource in assisting the operations, as well as working closely with leaders to achieve individual, departmental and company objectives.

The Senior Quality Care Specialist will be responsible for supporting and working with the Resolution Specialists.

Location: 55 M Street SE, Suite 520 Washington, DC 20003

What you’ll do:


* Coordinate responses to complaints/grievances to ensure high quality of care for Washington DC beneficiaries, including managing the dedicated telephone line


* Build out and maintain the initial notification process for incidents and accidents


* Manage the DC Quality Care email box to ensure receipt of grievances/complaints


* Manage escalated complaints


* Manage and ensure timely compliant resolutions of beneficiary issues


* Continuously educate employees on new processes and procedures


* Ensure beneficiary concerns are addressed which may require additional solution-based initiatives


* Provide operational improvement recommendations to Leadership 


* Provide hands-on training, as needed


* Other duties as assigned

What you’ll need:

Experience, Education & Certifications:


* A bachelor’s degree in either the following: Healthcare administration, public health, business administration, social work or related field


* Minimum of five years’ complaint resolution experience 


* Experience with root cause analysis, case tracking, reporting, and regulatory compliance


* Experience in complaints, grievances management, appeals, and member services within healthcare, managed care or regulatory environment

Skills:


* Project management skills, knowledge of healthcare, Medicaid programs, and leadership experience


* Ability to identify and respond to customer needs and circumstances 


* Knowledge of contract/client requirements 


* Ability to handle confidential information in a professional manner 


* Ability to acquire and maintain in-depth knowledge of department process and procedures


* Exemplary communications skills


* Strong leadership skills


* Knowledge of MTM protocols preferred


* Ability to maintain high level of confidentiality


* Moderate to advanced knowledge of Microsoft applications, including Word, Excel, Access; PowerPoint


* Knowledge of Medicaid grievance and appeal processes and relevant federal/state regulations

What’s in it for you:


* Health and Life Insurance Plans


* Dental and Vision Plans


* 401(k) with a company match


* Paid Time Off and Holiday Pay


* Maternity/Paternity Leave


* Casual Dress Environment


* Tuition Reimbursement


* MTM Perks Discount Program


* Leadership Mentoring Opportunities

Salary Min: $27.66

Salary Max: $32.00

This information reflects the base salary pay range for this job based on current national market data.

Ranges may vary based ...