Quality Control Reviewer

Qlarant is a not-for-profit corporation that partners with public and private sectors to create high quality, safe, and efficient delivery of health care and human services programs. We have multiple lines of business including population health, utilization review, managed care organization quality review, and quality assurance for programs serving individuals with developmental disabilities. Qlarant is also a national leader in fighting fraud, waste and abuse for large organizations across the country.  In addition, our Foundation provides grant opportunities to those with programs for under-served communities.

Best People, Best Solutions, Best Results

Job Summary:

Performs project management activities for successful implementation and completion of quality improvement projects in various delivery settings which includes the coordination of activities of those assigned to their team. May work on any contract for which training has been provided.

Essential Duties and Responsibilities include the following. Other duties may be assigned.

• Responsible for a number of projects utilizing a collaborative team of QI Consultants/QI Coordinators. Works with interdisciplinary team to plan and develop strategies to meet contract objectives and to assure activities are completed in a timely manner.
  • Plans and monitors workflow based on contract requirements and shifting demands to ensure work meets all contract deliverable deadlines, both internal and external.
  • Monitors and documents progress of assigned quality initiatives and studies.
• Demonstrates knowledge of the project/scope of work and alerts the Project Manager/Director of process variations.
  • Assists Project Manager/Director in development of solutions to problems as they relate to procedures and processes, as well as identified problems.
  • Identifies and resolves customer support and program issues
• Develops and fosters relationships with providers, stakeholders, team members, partners and ancillary organizations coordinating activities and managing these relationships through the project duration.
  • Develops and keeps current database of contacts and interactions for assigned projects or contacts.
  • Participates in professional organizations to keep them apprised of activities as it relates to the contract and attends meetings/conferences as assigned.
• Identifies opportunities to improve processes and procedures and uses quality improvement tools to continuously improve all processes.
• Coordinates and/or leads meetings of all types, internal and external, and participates on and/or leads committees as assigned. This includes development and delivery of presentations for internal and external customers
• Maintains a comprehensive clinical and/or technical knowledge of all assigned projects relevant processes, and regulatory issues. Provides technical guidance to the analytical team.
• Prepares and maintains materials and information for provider use in QI initiatives or identified projects. Interacts with customers on-site, by phone, and via the web explaining QI initiatives, providing training, and technical support.
• Follows contract specific procedures and policies in conducting activities.

To perform the job successfully, an individual should demonstrate the following competencies:

• Analytical - Collects and researches data; Uses experience to complement data.
• Problem Solving and Critical Thinking - Identifies and resolves problems in a timely manner; Develops alternative solutions.
• Project Management - Develops project plans; Coordinates projects; Communicates changes and progress; Completes projects on time and budget; Manages project team activities.
• Customer Service - Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance.
• Change Management - Develops workable implementation plans; Communicates changes effectively; Builds commitment and overcomes resistance.
• Leadership - Inspires and motivates others to perform well; effectively influences actions and opinions of others; Accepts feedback from others and give appropriate recognition to others.
• Quality Management - Looks for ways to improve and promote quality; Demonstrates accuracy and thoroughness.
• Planning/Organizing - Prioritizes and plans work activities; Uses time efficiently; Plans for additional resources; Sets goals and objectives.
• Communication - Communicates effectively with people at all levels in the organization.

Computer Skills:

To perform this job successfully, an individual should have knowledge of database systems, Spreadsheet, Presentation, and Word Processing software. Familiarity with Project Management software desired.

Other Skills and Abilities:

• Ability to work independently with minimal supervision.
• Demonstrated ability to work with an interdisciplinary team and all levels of health care professionals.
• Ability to prepare and effectively communicate information through presentations.

Education and/or Experience:

• Bachelor's/Master’s degree in a health related or human service field preferred.
• At least two years of Quality Improvement experience OR certification/s in an applicable program such as CPHQ, ASQ, Managed Care or Case Management, PMP, Fraud Examiner, Compliance; or equivalent combination of education and experience.
• Based on contract requirements, clinical or technical experience and specific licensure may also be required.

Certificates, Licenses, Registrations: 

• CPHQ, ASQ, Managed Care or Case Management, PMP, Fraud Examiner, Compliance are desirable

Qlarant is an Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities.