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Corporate Functions & Operations WellCare - Operations Management Careers

Quality & Audit - Manager Job

Full Job Title: Mgr, Quality & Audit

Job Number: 1702143

Location: Tampa, FL

Date Posted: 5-15-2017

Manages audit functions of Enrollment Operations to ensure compliance with State and Federal Regulations

Reports to: Sr. Dir. Appeals & Retro Review

Department: HS- Appeals & Grievances

Location: Tampa, FL.


Essential Functions:

  • Partners with key stakeholders across all lines of business during external and internal audits in order to provide appropriate documentation and ensure the audits are conducted in accordance with Audit Methodology and professional standards.
  • Develops QA standards to monitor and improve adherence to department standards, policies and procedures, templates, formats and guidelines.
  • Develops and implements studies of business function systems to include score, action plans, and analysis. Prepares narratives and graphic display of the findings.
  • Communicates audit results to senior management on a regular schedule.
  • Focuses on developing a systematic report quality results to help process owners root cause and prioritize their process or training opportunities.
  • Direct involvement in building collaborative relationships with other departments to resolve quality issues and barriers.
  • Leads and/or performs special projects, when necessary.
  • Performs administration and personnel duties to include associate development, team meetings, hiring activities, etc.
  • Performs other duties as assigned.
Additional Responsibilities:Candidate Education:
  • Required A Bachelor's Degree in a related field
  • Required or equivalent work experience
Candidate Experience:
  • Required 3 years of experience in relevant work as a senior, lead associate and / or supervisor - for internal applicants.
  • Required 5 years of experience in directly relevant work experience to include at least 3 years as a senior, lead associate and / or supervisor. Solid understanding of managed care and its place in the health care industry. directly relevant work experience to include at least 3 years as a senior, lead associate and / or supervisor. Solid understanding of managed care and its place in the health care industry. relevant work to include at least 3 years as a senior, lead associate and / or supervisor. Solid understanding of managed care and its place in the health care industry - for external applicants. directly relevant work experience to include at least 3 years as a senior, lead associate and / or supervisor. Solid understanding of managed care and its place in the health care industry
Candidate Skills:
  • Intermediate Demonstrated leadership skills
  • Intermediate Ability to lead/manage others
  • Advanced Demonstrated written communication skills
  • Advanced Demonstrated interpersonal/verbal communication skills
  • Intermediate Demonstrated ability to deal with confidential information
  • Advanced Demonstrated organizational skills
  • Intermediate Ability to effectively present information and respond to questions from peers and management
  • Intermediate Other Solid understanding of managed care and the health care industry in general
  • Intermediate Other Strong background in Quality Improvement, including planning, evaluation, quantitative analysis, and practical application of quality management principles in a managed care environment
  • Intermediate Other Knowledgeable of current trends in quality improvement in managed health care
  • Intermediate Other Knowledgeable of AHCA and CMS regulatory requirements
  • Intermediate Other Knowledgeable of HEDIS and CAHPS requirements
Technical Skills:
  • Required Intermediate Microsoft Excel
  • Required Intermediate Microsoft PowerPoint
  • Required Intermediate Microsoft Word
  • Required Intermediate Microsoft Outlook
    *LI-AD1

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Last Updated On: 12/9/2015