This site uses cookies. To find out more, see our Cookies Policy

Quality Improvement Assistant in Orange at Prospect Medical Systems

Date Posted: 6/20/2018

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    600 City Parkway West
    Orange
  • Experience:
    Not Specified
  • Date Posted:
    6/20/2018
  • Job ID:
    9805

Job Description



Quality Improvement Assistant

We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for care. We build comprehensive networks of quality healthcare services that are designed to offer our patients highly coordinated, personalized care and help them live healthier lives. Through collaboration, we strive to provide all of our patients and medical group members with the quality, affordable healthcare they need and deserve.

This position has the responsibility to coordinate all the administrative and clerical functions in the Quality Improvement Department.



Job Responsibilities/Duties

  • Receive and collect grievance information from the health plans, customer service, and any other source.
  • Request copies of medical records and/or written response as directed by health plan / QI Nurse and other pertinent information from provider offices. 
  • Log and document all grievances, by health plan, in a confidential manner for future tracking and trending in CSR and database. 
  • Follow-up with provider offices if requested information is not received in the QM Department in a timely manner and report to QI Nurse. 
  • Assist with the gathering of information for audits, studies, and any other reports, as needed. 
  • Assist with the processing and sending of required reports to the health plans.
  • Resource person for the health plans, providers and staff regarding the QI/MM Department.
  • Member outreach calls on approved urgent referrals. 
  • Provider outreach on pended referrals. 
  • Update and Amend Case Management logs. 
  • Create carve-out letters and process per NCQA standards. 


Qualifications

Minimum Education: High School Diploma.

Minimum Experience: Quality Improvement Assistant with prior HMO/Medical Group experience.

Req. Certification/Licensure: None.



Employee Value Proposition

Prospect Medical Holdings, Inc., is guided by a diverse and highly experienced leadership core. This group maintains the vision that has made Prospect a needed difference-maker in the lives of so many patients today, and many executives contribute to our continued efforts. As a member of our highly effective team of professionals you will receive:

  • Company 401K
  • Medical, dental, vision insurance
  • Paid time-off
  • Life insurance


How to Apply

To apply for this role, or search our other openings, please visit http://pmh.com/careers/ and click on a location to begin your journey to a new career with us!

We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.

EEOC is the Law: https://www1.eeoc.gov/employers/poster.cfm