REMOTE - Enterprise Clinical Quality Specialist III - MUST be an RN - R10537

Health Care with Heart. It is more than a tagline; it’s how we do business. CareSource has been providing life-changing health care to people and communities for 30+ years and we continue to be a transformative force in the industry by placing people over profits. CareSource is and will always be member-first. Even as we grow, we remember the reason we are here – to make a difference in our members’ lives by improving their health and well-being. Today, CareSource offers a lifetime of health coverage to more than 2 million members through plan offerings including Marketplace, Medicare products and Medicaid. With our team of 4,500+ employees located across the country, we continue to clear a path to better life for our members. Visit the "Life"​ section to see how we are living our mission in the states we serve.

Enterprise Clinical Quality Specialist III is responsible for performing quality monitoring activities of clinical and non-clinical areas for compliance with National Committee for Quality Assurance (NCQA) and identified State and Federal requirements.

Responsible for monitoring activities via Guiding Care, OnBase, Streamline, Facets, MHK, and CareSource policy and procedures Assist in identifying and evaluating the organizations risk areas related to accreditation, state and federal requirements and provide input to effectively communicate evaluation and recommendations to management Responsible for conducting independent random and scheduled monitoring activities for departments associated with NCQA. Additionally, responsible for monitoring of some state and federal requirements Analyze the quality assurance results and make recommendations for corrective action when problems are identified Provide feedback to all associated departments with quality monitoring variances and document corrective action and follow up Provide documentation for discussion at meetings and prepare minutes with follow-up action items Prepare statistical reports outlining departmental error rates/trends monthly for review Responsible for follow-up on designated case and file review findings Functions as a resource for business and clinical personnel in resolving questions related to documentation requirements and quality monitoring activities Responsible for ongoing educational programs and individual education within all departments that have quality monitoring requirements related to accreditation, state and federal requirements Assist in preparing cases/files for NCQA Onsite Survey file reviews Perform any other job duties as requested