Responsible for identifying, assessing, and mitigating risks, developing and implementing internal policies and procedures, and ensuring that activities are consistent with goals and objectives. Establish and implement quality assurance and compliance processes as it relates to Provider Relations and One Call networks. Monitor the implementation of effective risk management practices to safeguard the quality performance and compliance of the provider community, including service standards.
General duties and responsibilities:
Document and build consensus pertaining to roles and responsibilities for the various aspects of the Compliant Network Management program, including ongoing monitoring processes
Works closely with management to assist in or develop/implement an overall quality plan for the functional area.
Reviews progress toward quality assurance plans regularly with management, teams, and internal customers to make modifications as necessary
Coordinate Regulatory activities for the assigned One Call Providers, with the Provider Relations Account Management team
Assist Provider Relations Account Management team with implementation activities surrounding compliance, ensuring a timely implementation and regulatory compliance of the program
Build and maintain repeatable processes to validate PR personnel are appropriately implementing regulations to maintain program compliance with all requirements
Determine strategy for testing, capture and communication of quality assurance monitoring results
Facilitate repository documentation and management in support of enterprise retention and destruction policy
Work with Provider Education and Training to enhance provider network awareness as to their One Call obligations in order to mitigate risk to One Call and safeguard the quality performance of the network.
Validate monitoring of providers recommended for remediation, with a focus on Repeat Offenders.
Coordinates with VMT, Enterprise Compliance, Risk Management, and Provider Relations on the plan for credentialing compliance.
Maintain current training / certification regarding compliance best practices and pursue enhanced knowledge as to policy and procedure management, quality assurance and control.
Provides information, presentations and/or other materials to facilitate the efforts of the Provider Quality and Credentialing Committee/s.
Provides guidance to teams on quality methodologies and processes, educates them on their responsibilities/accountabilities for the purpose of achieving on-time and quality deliverables
Makes recommendations and directs improvements to management
Documents non-compliance to policies, processes, and standards and assists in their resolution
Participates in the design, monitoring, and analyzing of performance metrics program for quality improvement initiatives
Performs other related duties as required
A Bachelor’s Degree in Business Administration or other related discipline is preferred; or equivalent combination of education and experience that is required for the specific job level.
General knowledge, skills and abilities:
Broad knowledge of One Call’s products and services, business practices and processes
Some proficiency in at least one appropriate quality management and improvement methodology (e.g., Total Quality Management (TQM), Six Sigma
Knowledge of / experience with provider credentialing
Excellent facilitation, consulting and delivery of complex content
Maintain up-to-date understanding of industry trends that affect market areas.
Maintain knowledge of One Call’s product lines in order to offer solutions to clients that will result in successful outcomes
Proficiency in quality management methods, tools and technologies
Proficiency in project management
Excellent verbal and written communication skills to technical and non-technical audiences of various levels in the organization (e.g., executive, management, individual contributors)
Strong training/presentation skills to educate the organization on new or updated processes
Willingness to share relevant process, and/or industry knowledge and expertise to other resources
Excellent analytical, decision-making, problem-solving, interpersonal, team-building, negotiation, conflict management and time management skills
Ability to persuade and influence others on the best approach to take
Is resourceful and proactive in gathering information and sharing ideas