Senior Quality Care Specialist
MTM, Washington, District of Columbia, United States
Senior Quality Of Care Specialist
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.
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
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
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
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 on the job's location. We offer competitive pay that varies based on individual skills, experience, and other relevant factors. We encourage you to apply to positions that you are interested in and for which you believe you are qualified. To learn more, you are welcome to discuss this with us as you move through the selection process.
Equal Opportunity Employer: MTM is an equal opportunity employer. MTM considers qualified candidates with a criminal history in a manner consistent with the requirements of applicable local, State, and Federal law. If you are in need of accommodations, please contact MTM's People & Culture.
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.
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
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
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
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 on the job's location. We offer competitive pay that varies based on individual skills, experience, and other relevant factors. We encourage you to apply to positions that you are interested in and for which you believe you are qualified. To learn more, you are welcome to discuss this with us as you move through the selection process.
Equal Opportunity Employer: MTM is an equal opportunity employer. MTM considers qualified candidates with a criminal history in a manner consistent with the requirements of applicable local, State, and Federal law. If you are in need of accommodations, please contact MTM's People & Culture.