Claims Quality Audit Director jobs in Miami, FL

Well established healthcare system in S. Florida is seeking a Director, Quality Assurance with significant experience working in Certified Community Behavioral Health Clinic environments. This individual will work with our team to ensure that we continue to provide all patients with high quality and efficient care.

Under general direction, performs a variety of professional management activities in the planning, development, and implementation of the organizations Quality Improvement Implementation Plan. This position is responsible for quality review and compliance in accordance with policies and performance agreements and Federal rules and regulations, and performs related work as assigned.

Responsibilities:

• Develop, coordinate and manage quality management and regulatory compliance functions.
• Oversee and actively guide utilization review, medication monitoring, confidentiality of records and peer review in accordance with federal, state, and local government requirements.
• Work closely with managers in developing program policies which meet federal, state, and local government requirements. Provide lead direction to our team regarding quality assurance programs and expected outcomes.
• Oversee the preparation and implementation of four Performance Improvement Projects.
• Prepare and implement the Quality Improvement Work Plans and Competency Plans
• Attend relevant state and regional meetings.
• Facilitate the design, planning, and implementation of QA studies and activities aimed to improve quality of care for patients and ensure QA project design is based upon sound quality improvement methodology.
• Uses sound analytical tools to complete quantitative and qualitative analysis of quality data and develop clinical improvement opportunities.
• Assure that all internal and external QA activities are documented and reported appropriately and timely.
• Analyzes and evaluates performance improvement data to identify trends in quality of care concerns.
• Provide support for the accomplishing of QA departmental goals as well as strategic plan.
• Responsible for maintaining, reviewing, and updating the QA Plan.
• Assists with the development and implementation of various quality improvement initiatives.
• Tracks and analyzes trends and outcome reports and advises management on areas for improvement.
• Interacts with clinical staff in primary care, and behavioral health to assist with quality process improvement and clinical needs.
• Assesses, observes, and implements all Quality Assurance initiatives through the organization.

Requirements:

• Strong working knowledge of:
• Health care laws and regulations, including HIPAA and Mental Health
• Principles and practices of information privacy laws, access, release of information and release control technologies
• Principles and methods for practices of project planning, system analysis, monitoring, problem solving, implementation and evaluating, development and evaluation.
• Master's degree from an accredited college or university in a related field
• 5 years experience in a similar role
• 3 years of responsible experience in a supervisory, administrative, or managerial capacity in compliance.