Lead Quality Assurance Specialist
CCS
Manager, Specialty Therapy and Rehabilitation Services
Centene Corporation
full-time
Posted on:
Origin: • 🇺🇸 United States
Visit company websiteSalary
💰 $86,000 - $154,700 per year
Job Level
Mid-LevelSenior
About the role
- Manage Specialty Therapy and Rehabilitation Services (STRS) clinical services including management and marketing of clinical services
- Manage clinical services including oversight of clinical policies and procedures and day-to-day operation
- Oversee the provider outreach and training activities pre and post implementation
- Ensure compliance with established initial and concurrent review, referral, and authorization policies, procedures and processes
- Ensure all programs and clinical operations are in full compliance with state and federal regulations, including HIPAA
- Ensure payer contract clinical deliverables are met
- Monitor the effectiveness of existing procedures and outreach/intervention efforts and ensure full compliance with physical, occupational, speech, and home health scope of practice state guidelines
- Analyze data, monitor trends and recommend potential quality improvement opportunities including provider issues, service gaps, member needs
- Ensure accurate and timely reporting to health plan partners on authorizations, denials, appeals, provider outreach, call center metrics, and utilization trends to include analytics and interventions
- Performs other duties as assigned
- Complies with all policies and standards
Requirements
- Master’s degree in Speech, Occupational or Physical Therapy or equivalent.
- 5+ years of specialty therapy or rehabilitation services experience.
- Thorough knowledge of a specialized or technical field such as case and/or utilization management, including review procedures and educational services.
- Supervisory experience preferred.
- Current certification/licensure in Speech-Language Pathology, Occupational Therapy, or Physical Therapy in state of practice.
