Req# 28535 Aultman Health Foundation, CANTON, OH AULTCOMP MCO INC Aultman Health Foundation Full Time, Day Shift, varies PURPOSE OF POSITION: The primary purpose of the Quality & Medical Management Supervisor is responsible to coordinate and supervise the day to day functions of the medical management department in an efficient, cost-effective manner in accordance with governing and accrediting bodies' policies and standards. The Quality & Medical Management Supervisor offers guidance to the staff to assure all applicable laws, rules, guidelines, policies, URAC standards and contractual requirements are adhered to. The Quality & Medical Management Supervisor will accomplish this goal by devoting on average thirty to forty percent of their time on quality outcomes. Continually leading by example to provide and facilitate efficient, quality service at all times. RESPONSIBILITIES & EXPECTATIONS: Establish, maintain and enforce policies and procedures to conform to all governing and accrediting bodies to include but not limited to: URAC, Ohio Bureau of Workers' Compensation (BWC), and the Industrial Commission(IC). Coordinate the URAC Accreditation process: Primary contact Manage all incoming and outgoing communications. Assure attestation and any organizational changes are completed timely. Build the URAC application and its submission to the URAC Accreditnet portal. Coordinate the on-site audit and assure all documentation is available and flagged for their review. Collect, analyze and report performance measures as required by URAC. Coordinates quality improvement data collection/evaluation process: Collects/evaluates data for medical management, vocational rehabilitation, billing, first report of injury and other processes, as needed. Reports findings to the management staff at AultComp MCO and the Quality Taskforce. Develops quality work and action plans. Writes and maintains QI projects as determined by the QI Taskforce. Coordinates and/or oversees audits: BWC Audits and/or responses to CAR Internal Audits Assists Manager and Systems & Finance Analyst with SSAE16 Audit Coordination of policymaking regarding AultComp MCO's/BWC's guidelines and policies. Evaluates and coordinates AultComp MCO policy changes to remain compliant with URAC standards. Provides educational support for staff, injured worker, medical provider, and employer regarding the workers' compensation process, URAC, BWC/AultComp MCO guidelines. Documents clear concise notes in the system following activity on cases. Process Improvement: Continuously reviews, recommends and implements improvement steps, as needed or directed. Seeks supervisory guidance/approval as appropriate. Portrays professional image: follows dress code; communicates with internal and external customers in a professional manner, including appropriate verbal and written grammar. Promotes and demonstrates professional standards to enhance the development of the department including: Performs all job functions in an independent manner (as needed or directed) Recognizes and performs job functions with little or no supervision Demonstrates strong organizational skills Responds positively to change in work flow as needed Offers assistance to co-workers (as needed) Maintains flexibility to meet department needs, including adjusting work hours Consistently completes assigned work in required time frame; completes other duties as required Collaborates and cooperates with co-workers, supervisors, etc., creating a productive working relationship throughout the organization Actively seeks and pursues opportunities to make a contribution and demonstrates desire for learning Practices Ethical Conduct: Demonstrates honesty and integrity in all functions and relationships Maintains Ault