Non-Clinical Supervisor, CQM - Regal Medical Group

Position Summary:

CQM Supervisor manages CQM non-clinical auditors to monitor the regulatory compliance and quality of process in daily Non-Clinical Utilization Management (UM) activities under supervision of manager. The Supervisor will be responsible for UM case file live audit including assign driver and presenter and ensure their appropriately performance. The Supervisor will be responsible for UM system control monitoring and UM process monitoring especially the process not requiring clinical decisions. This position requires knowledge of comprehensive regulation, UM policies & procedures, UM system, UM audit and quality improvement.

Essential Duties and Responsibilities include the following:

• The role must be familiar with Non- Clinical UM regulations, Non-Clinical UM process and Non-Clinical UM system.
• The role is good at assign workload with management skills.
• Good at presentation case files and handle interview for nonclinical questions.
• Good at design audit tool to monitor Non-Clinical UM process done by nonclinical staff.
• Good at communication with internal clients and external customers.
• Good at training employees by using P&Ps, audit tools.
• Good at providing constructive feedback and active communication skills.
• Summarize the quality monitoring findings, analyze root causes and propose of quality improvement plans.
• Suggest and design focus audits that might be help Non- Clinical UM improve the compliance of process.
• Request decision support to create and improve the Non-Clinical UM monitoring reports based on UM P&Ps changes.
• Ensure auditors complete audits and remediation within required timeframes.
• Collaborate with Non-Clinical UM team to ensure any focus audited area being monitored, and the quality of process being tracked.
• Work with operational teams to monitor the effectiveness and efficiency of the process change made for quality improvement.
• Ensure new process procedure being implemented accurately through reports and case files review.
• Report issues found to prior authorization compliance director based on findings.
• Review updated policy and procedure, be able to update the quality monitoring tool based on the policy and procedures. .
• Keep all evidence of quality monitoring projects.
• Maintain and track daily reports received from decision support team.
• Report issues related to internal processes (i.e. timeliness issues) to the CQM manager.
• Attend department meetings, in-house service, trainings and complete acknowledgement within required timeframe.
• All other duties as directed by management.

Education and or / Experience:

• Graduate from high school or above.
• Three to five (3-5) years of utilization management (non-clinical) experience.
• Minimum two (2) years of UM supervision (non-clinical) or UM auditor (non-clinical) experience preferred.
• Proficient in MS Office programs (i.e., Word, Excel, Outlook, Access, and Power Point).
• Typing 60 words per minutes with accuracy.
• Ability to deal with responsibility with confidential matters.
• Must have strong analytical, creative problem solving, and organizational skills.
• Ability to work in a multi-task, high stress environment.
• Ability to strategize effectively, execute within timelines, and deliver quality results
• Ability to thrive in a fast-paced environment where flexibility and being proactive are essential
• Must be able to handle multiple projects at one time, reset priorities day-to-day to meet deadlines, and know when to ask for assistance and direction when working with conflicting priorities.
• Must be self-motivated, pleasantly aggressive and realistically ambitious and have high personal ethics.
• Must have the ability to work with all levels of management and have the ability to develop positive working relationships with different divisions in the company.

The pay range for this position at commencement of employment is expected to be between $70,304 - $72,000 annually however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.

The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.

Details of participation in these benefit plans will be provided if an employee receives an offer of employment.

If hired, employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.

As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.

Full Time Position Benefits:

The success of any company depends on its employees. For us, employee satisfaction is crucial not only to the well-being of our organization, but also to the health and wellness of our members. As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life.

Our dedication to our staff is evident in our comprehensive benefits package. We offer a very generous mixture of benefits, including many employer-paid options.

Health and Wellness:

• Employer-paid comprehensive medical, pharmacy, and dental for employees
• Vision insurance
• Zero co-payments for employed physician office visits
• Flexible Spending Account (FSA)
• Employer-Paid Life Insurance
• Employee Assistance Program (EAP)
• Behavioral Health Services

Savings and Retirement:

• 401k Retirement Savings Plan
• Income Protection Insurance

Other Benefits:

• Vacation Time
• Company celebrations
• Employee Assistance Program
• Employee Referral Bonus
• Tuition Reimbursement
• License Renewal CEU Cost Reimbursement Program
• Business-casual working environment
• Sick days
• Paid holidays
• Mileage

Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance.