Quality Assurance Manager

MES is looking for Quality Assurance Manager to join our team!

The Quality Assurance Manager is responsible for providing direction, training, continuing education and overall support to the Quality Assurance Department and ensures reports are completed at the highest level of quality and integrity and in full compliance with client contractual agreement, regulatory agency standards and/or federal and state mandates. This position is responsible to conduct ongoing research, develop and implement departmental procedures and enhancements and strive to reach all departmental performance and financial goals.

The schedule for this role is Monday to Friday 8:00am to 5:00pm.

ESSENTIAL JOB FUNCTIONS

• Directly oversee department to ensure staff is managed effectively and consistent with all regulatory provisions, company policy and HIPAA standards.
• Ensure daily workflow is managed efficiently and when necessary, make adjustments to achieve daily, weekly and monthly goals.
• Maintain control of operation costs in order to ensure profitability is achieved.
• Create and provide support, training, tools, and techniques to assist staff in achieving department excellence and maintaining company standards.
• Review and analyze quality assurance data and create and implement improvement strategies to ensure the highest quality product is achieved while promoting increased productivity.
• Organize and attend staff meetings as required and ensure communication pertaining to all lines of business working effectively together is achieved.
• Communicate change effectively and assists in preparing and supporting those affected by change. Monitor transition and evaluate results to ensure successful results are achieved.
• Oversee and assists in planning, assigning and directing employee's work performance and recognition.
• Oversee and assist as needed with quality assurance review of reports, correspondences, addendums or supplemental reviews.
• Respond promptly to customer service needs and resolve difficult customer service situations.
• Ensure clear, concise, evidence-based rationales have been provided in support of all recommendations and/or determinations.
• Ensure that all client instructions and specifications have been followed and that all questions have been addressed.
• Ensure each review is supported by clinical citations and references when applicable and verify all references cited are current and obtained from reputable medical journals and/or publications.
• Ensure the content, format, and professional appearance of the reports are of the highest quality and in compliance with company standards.
• Ensure that the appropriate board specialty has reviewed the case in compliance with client specifications and/or state mandates and is documented accurately on the case report.
• Verify that the peer reviewer has attested to only the facts and that no evidence of reviewer conflict of interest exists.
• Ensure the provider credentials and signature are adhered to the final report.
• Identify any inconsistencies within the report and contacts the Provider to obtain clarification, modification or correction as needed.
• Ensure all federal ERISA and/or state mandates are adhered to at all times.
• Provide insight and direction to management on consultant quality, availability and compliance with all company policies and procedures and client specifications.
• Promote effective and efficient utilization of company resources.
• Participate in various educational and or training activities as required.
• Perform other duties as assigned.

ESSENTIAL MANAGERIAL RESPONSIBILITIES

• Carrying out all responsibilities in accordance with the company's standards, policies, and all applicable employment laws.
• Managing and monitoring workflow and providing support, training, and techniques to assist staff in achieving department daily/weekly/monthly goals and standards.
• Encouraging positive morale, maintaining harmony among staff, and resolving grievances when necessary.
• Overseeing the completion and approval of employee timecards and coordinating overtime needs with management and staff as needed.
• Actively participating in the department's staffing requirements including hiring, onboarding, and separating of employees.
• Creating and implementing plan to meet department's goals and metrics based on workload and client needs.
• Communicating change effectively and supporting those affected by change.
• Managing insubordinate staff when warranted and initiating coaching or corrective actions as required and/or directed by upper management.
• Evaluating staff needs and performance, providing periodic feedback to staff and reporting any performance concerns and/or recommendations growth opportunities to management.
• Actively participating and successfully conducting annual performance evaluations.

Education and/or Experience:

• High school diploma or equivalent required.
• Minimum of six years related experience; or equivalent combination of education and experience required.
• Knowledge of the insurance industry preferably claims management relative to one or more of the following categories: workers' compensation, no-fault, liability, and/or disability preferred.

Qualifications:

• Must have strong knowledge of medical terminology, anatomy and physiology, medications and laboratory values.

• Must be able to add, subtract, multiply, and divide in all units of measure, using whole numbers and decimals; Ability to compute rates and percentages.
• Must be a qualified typist with a minimum of 40 W.P.M preferred.
• Must be able to operate a general computer, fax, copier, scanner, and telephone.
• Must be knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet.
• Must possess excellent skills in English usage, grammar, punctuation and style.
• Ability to follow instructions and respond to upper managements' directions accurately.
• Must demonstrate accuracy and thoroughness. Look for ways to improve and promote quality and monitor own work to ensure quality is met.
• Must demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed.
• Must be able to execute independent actions and take calculated risks when needed. Use good judgment and includes the appropriate people in the decision-making process.
• Ability to analyze problems involving multiple interrelated causes. Where necessary, gather information and applies complex concepts or methods to generate an effective solution.
• Must be able to work independently, prioritize work activities and use time efficiently.
• Must possess a working knowledge of medical and/or legal aspects of medical records and health information principles and/or liability.
• Must be able to maintain confidentiality.
• Must be able to demonstrate and promote a positive team -oriented environment.
• Must be able to stay focused and concentrate under normal or heavy distractions.
• Must be able to work well under pressure and or stressful conditions.
• Must possess the ability to manage and direct change, delays, or unexpected events appropriately.
• Ability to follow all company policies and procedures in effect at time of hire and as they may change or be added from time to time.

MES Solutions is a premier provider of independent medical examination and peer review services to the insurance, corporate, legal, and government sectors. Members of our credentialed medical panel conduct physical examinations or medical record reviews, delivering reports that assist clients in the resolution of automotive, disability, liability, and workers' compensation claims. MES has been providing services nationally since 1978 in accordance with the industry's highest standards of operating excellence and regulatory compliance.

MES offers a fast-paced team atmosphere with competitive benefits (medical, vision, dental), paid time off, and 401k.

Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, pregnancy, genetic information, disability, status as a protected veteran, or any other protected category under applicable federal, state, and local laws.