Claims Quality Audit Director jobs in Mcallen, TX
Claims Quality Audit Director directs and oversees the operations of the claims quality audit department to follow the audit policies, procedures and regulation. Provides professional knowledge and guidance on technical or procedural problems. Being a Claims Quality Audit Director creates claims audit policies and procedures. May recommend changes in claims processing procedures. Additionally, Claims Quality Audit Director typically Requires a bachelor's degree. Typically reports to top management. The Claims Quality Audit Director manages a departmental sub-function within a broader departmental function. Creates functional strategies and specific objectives for the sub-function and develops budgets/policies/procedures to support the functional infrastructure. To be a Claims Quality Audit Director typically requires 5+ years of managerial experience. Deep knowledge of the managed sub-function and solid knowledge of the overall departmental function. (Copyright 2024 Salary.com)
Recently Added Claims Quality Audit Director jobs
- United Migrant Opportunity Services
-
Allen, TX
FULL_TIME
-
Apply Now and complete an official UMOS application to be considered at UMOS.org. Resumes alone are not accepted.
Essential Duties and Responsibilities:
- Responsible for program compliance in Head Start systems, federal (HSPS, ADA, IDEA, OSHA), state (TX, WI, MO, AR Administrative Code), and local regulations, including policies/procedures and guidelines established by UMOS.
- Responsible for the development, monitoring, and reporting functions of the ECE program services division.
- Provide leadership and oversight in ongoing monitoring systems to ensure compliance and quality services and determine areas for training and technical assistance in the ECE program.
- Coordinate and oversee desk audits to ensure accurate Child Plus and Teaching Strategies GOLD data and performs mock reviews with both staff and providers in preparation Head Start Reviews
- Develop, organize, and implement requirements pertaining to compliance with Head Start regulations, including the annual Self-Assessment process, USDA monitoring, and the development of the quality improvement plans.
- Responsible for ensuring the Program Information Report (PIR) is completed accurately and timely submitted to the Office of Head Start.
- Responsible for developing, implementing, and directing the use of electronic tracking systems and methods for program monitoring and reporting and report findings and program trends.
- Leads the continuous quality improvement (CQI) process and program evaluation through monthly data collection, analysis, audit, and reporting, and implements performance improvement plans for identified areas.
- Uses a range of quality improvement tools and techniques to evaluate and successfully redesign processes toward improved performance.
- Transforms data into actionable information and communicates performance improvement priorities and results using narrative and the appropriate data visualization methods.
- Work in collaboration with the administrative staff to ensure integration of quality assurance and monitoring of program services being implemented across regions.
- Directs tracking and reporting of outcomes, monitoring, and follow-up of corrective action plans for all program service areas.
- Submits monthly reports leadership team regarding analysis on compliance reports detailing onsite and/or desktop observations, non-compliance areas, and action taken.
- Is responsible for the development, monitoring, and presentation of internal monitoring and compliance efforts.
- Leads monthly Quality Improvement meetings with leadership staff on program performance.
- In coordination with Administrative Program staff, responsible for the creation and development of the program's annual training plan based on program and staff trends and needs.
- Develop and provide administrative oversight for expenditures of quality assurance activities and program areas and ensure compliance with fiscal guidelines and program goals.
- In coordination with Program Directors, conduct quality control checks to contracted services in the scope of services, deliverables, and documentation.
- Provide administrative oversight, support, and strategies regarding program service and program goals implementation and ensures data and trends reflect program long-range goals achievement.
- Participates in program's marketing committee in the review and decision-making process to assure compliance with EOE, civil rights and/or other state or federal requirements regarding the advertisement of community events, general publicity, and advertisement.
- Research areas for best practices and system improvement to be implemented by Head Start program and maintain a thorough knowledge of Head Start policies and procedures, changes, and updates to Federal, State, and Local regulations.
- Attends meetings, seminars, workshops, and performs other duties as assigned and necessary.
Qualifications:
- Bachelor’s Degree in Early Childhood Education, Public Health Administration, Social Work, or related field. Master’s Degree preferred.
- Five years' experience in program monitoring, evaluation, training and/or supervision/management staff.
- Must be able to plan, coordinate, report, and monitor the Health/Nutrition Services Program.
- Basic computer skills; good oral and written communications skills.
- Must have reliable automotive transportation, a valid driver's license, and appropriate automotive liability insurance.
- Willing to travel and work irregular hours.
Work Environment, Physical, and Sensory Demands:
The demands described here are representative of those that must be met by an employee to successfully perform the job functions. Reasonable accommodations will be considered to enable individuals with disabilities to perform the essential job functions.
Physical Demands:
- Employee is frequently required to stand, walk, sit, bend.
- Occasionally required to lift and /or move up to 20 lbs.
- Occasionally required to drive.
- Frequently exposed to moderate temperature generally encountered in a controlled temperature environment.
- Noise level in this work is usually quiet to moderate.
Tools & Equipment Used:
- Phones, computer system.
- Fax machine, copy machine, laminator, computer, calculator.
- Use first aid equipment, fire extinguisher.
Usage varies by position.
Additional Eligibility Requirements:
Employment with UMOS is contingent upon successful completion of a criminal background check prior to employment.
Apply Now and complete an official UMOS application to be considered at UMOS.org. Resumes alone are not accepted.
UMOS is an equal opportunity Affirmative Action employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.
Education
Required- Bachelors or better in Public Administration
- Bachelors or better in Social Work
- Masters or better in Early Child Care & Development
Skills
Required- Managerial Skills
- Organizational skills
- Time Management Skills
- Presentation Skills
- Communication
Behaviors
Preferred- Detail Oriented: Capable of carrying out a given task with all details necessary to get the task done well
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)
- 8 Days Ago
- UMOS, Inc.
-
Mcallen, TX
FULL_TIME
- Apply Now and complete an official UMOS application to be considered at UMOS.org. Resumes alone are not accepted. Essential Duties and Responsibilities: Responsible for program compliance in Head Star...
- 8 Days Ago
- NOVOCO
-
Allen, TX
FULL_TIME
- Position Summary Novogradac & Company LLP is searching for a Manager to join our fast-growing firm. The Manager will manage a variety of tax, audit and other assignments as designated by the Principal...
- 7 Days Ago
- NOVOCO
-
Laredo, TX
FULL_TIME
- Position Summary Novogradac & Company LLP is searching for a Manager to join our fast-growing firm. The Manager will manage a variety of tax, audit and other assignments as designated by the Principal...
- 10 Days Ago
- Security First Federal Credit Union
-
Edinburg, TX
FULL_TIME
- ESSENTIAL JOB FUNCTIONS 1. Assists in the essential clerical functions of Compliance and Internal Audit. Facilitates the identification of risk across business lines by pulling daily reports that will...
- 12 Days Ago
- NOVOCO
-
Laredo, TX
FULL_TIME
- Position Summary Novogradac & Company LLP is searching for a Senior Accountant to join our fast-growing firm. The Senior Accountant will manage a variety of tax, audit and other assignments as designa...
- 12 Days Ago
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- Mcallen, TX
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0 Claims Quality Audit Director jobs found in Mcallen, TX area
- Johnson Controls International
-
Apodaca, Nuevo León
- What you will do: This position is to be fulfilled by a focused and self-motivated engineer to work in a dynamic industr...
- 4/15/2024 12:00:00 AM
- Johnson Controls International
-
Apodaca, Nuevo León
- MANUFACTURING ENGINEER – Welding Lean Manufacturing Engineer This position is to be fulfilled by a focused and self-moti...
- 4/14/2024 12:00:00 AM
- Johnson Controls International
-
Apodaca, Nuevo León
- What you will do? You will lead the process for the procurement of 3rd party direct materials for JCI’s Chillers busines...
- 4/13/2024 12:00:00 AM
- Johnson Controls International
-
Apodaca, Nuevo León
- MANUFACTURING ENGINEER – Harness This position is to be fulfilled by a focused and self-motivated engineer to work in a ...
- 4/13/2024 12:00:00 AM
- Johnson Controls International
-
Apodaca, Nuevo León
- MANUFACTURING ENGINEER – Assembly Lean Manufacturing Engineer This position is to be fulfilled by a focused and self-mot...
- 4/13/2024 12:00:00 AM
- Johnson Controls International
-
Apodaca, Nuevo León
- MANUFACTURING ENGINEER – Sheet Metal Lean Manufacturing Engineer This position is to be fulfilled by a focused and self-...
- 4/13/2024 12:00:00 AM
- Johnson Controls International
-
Apodaca, Nuevo León
- Johnson Controls is a global diversified technology and multi industrial leader serving a wide range of customers in mor...
- 4/12/2024 12:00:00 AM
- General Dynamics Information Technology
-
- GDIT has an exciting opportunity for a Sr. Network Administrator to support U.S. Army Europe as part of our EMITS progra...
- 4/12/2024 12:00:00 AM
About Mcallen, Texas
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