CURRENT SPECTRUM HEALTH TEAM MEMBERS – Please apply through Find Jobs from your Workday team member account. This career site is for Non-Spectrum Health team members only.

Job Description

Job Summary

The Supervisor of Operational Quality and Assurance is responsible for leading a team of quality auditors. This leader ensures the accurate inspection of people and processor performance is meeting the expected benchmarks set by Priority Health. These quality transactions inspect and assure accuracy in enrollments, plan set up, group installations and claim payments. Responsibilities include regulatory and Soc compliance standards are met, controls are regularly reevaluated and discussed with business leaders, results of findings are delivered in a way that identifies trends and creates process improvement efficiencies. Coordination of trainings and finding opportunities for automation are among the responsibilities to leading this team and ensuring development of team is on the forefront of our accountabilities.


Provide leadership and direction to assigned auditors to assure that goals and standards of all areas are being met. Responsible for providing leadership support for quality efforts. Responsible to coordinate the development and implementation of audits and strategies to improve operational quality. Provide technical and analytical support to specific quality audit initiatives. Responsible for supporting multiple complex audits by leading teams in researching and analyzing business requirements and prototyping audits. Plan, monitor and track quality improvement initiatives. Have a sound understanding of quality improvement requirements, standards and objectives. Devises or modifies procedures to solve complex problems, considering quality scope, capacity, resource availability, operating time and form of desired results. Includes analysis of business and customer needs, documentation of requirements, and translation into audit requirements. Participates in quality leadership governance.

Essential Functions

• • Manage the day to day- keep audits on time, ensure they follow the standard process, ensure capacity needs are planned for and met.
  • Monitor inventory and turnaround times, resolving any issues proactively before deadlines are missed.
  • Know all data elements produced by audits. Be able to extract and analyze auditing data to identify insights into quality trends as well as assess capacity and resourcing needs.
  • Be able to confidently speak to all audits as well as current findings of these audits.
  • Detect when standard auditing processes are not being followed and where improvement opportunities exist. Lead team to address and resolve issues and concerns.
  
• • Nurture a collaborative and curious team culture through change.
  • Build relationship with peers and customers to build trusted partnerships.
• • Support the quality manager in development, planning and execution of team initiatives to support organizational strategies.
  • Be able to connect audits to strategic objectives and realign where auditing is not meeting strategic goals.
• • Project manage audit projects, serve as a change agent for the team.
  • Support the quality governance committee in coordination with the quality manager.
• • Be knowledgeable on industry standards for health payer operational quality auditing standards and structure and ensure alignment to industry standard. Stay up to date on industry changes.
• • Ability to partner and collaborate with outside departments to discuss trends and action plans

Qualifications

• Required Bachelor's Degree or equivalent or an equivalent level of experience in a health or insurance related industry

• 7 years of relevant experience in managed care operations. Required
• 5 years of relevant experience Leadership and/or analyst experience with demonstrated experience in operational quality analysis, data analysis, and complex problem solving Required
• Leadership of operational quality projects. Required
• 2 years of relevant experience Leading teams to audit managed care operational functions. Demonstrated ability to effectively implement operational quality audits that have driven operational quality evaluation and action. Required

Primary Location

SITE - Priority Health - 1241 E Beltline - Grand Rapids

Department Name

PH - Operations Development and Quality

Employment Type

Full time

Shift

Weekly Scheduled Hours

40

Hours of Work

8am to 4pm

Days Worked

Monday, Tuesday, Wednesday, Thursday, Friday

Weekend Frequency

N/A

Spectrum Health requires all team members to receive the COVID-19 vaccinations subject to certain exclusions based on the team member’s job category. Spectrum Health is committed to granting reasonable accommodations in accordance with applicable laws.

Accommodation Notice: If you are a qualified individual with a disability, you may request a reasonable accommodation in Spectrum Health's application process. Contact us at 616-486-SHHR (7447).

Spectrum Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, sexual orientation, veteran status, or any other legally protected

category. See more here.