Claims Quality Audit Director jobs in Washington

Claims Quality Audit Director directs and oversees the operations of the claims quality audit department to follow the audit policies, procedures and regulation. Provides professional knowledge and guidance on technical or procedural problems. Being a Claims Quality Audit Director creates claims audit policies and procedures. May recommend changes in claims processing procedures. Additionally, Claims Quality Audit Director typically Requires a bachelor's degree. Typically reports to top management. The Claims Quality Audit Director manages a departmental sub-function within a broader departmental function. Creates functional strategies and specific objectives for the sub-function and develops budgets/policies/procedures to support the functional infrastructure. To be a Claims Quality Audit Director typically requires 5+ years of managerial experience. Deep knowledge of the managed sub-function and solid knowledge of the overall departmental function. (Copyright 2024 Salary.com)

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DIRECTOR, QUALITY AUDIT
  • BrightSpring Health Services
  • SEATTLE, WA FULL_TIME
  • Our Company

    BrightSpring Health Services

    Overview

    The Quality Audit Director partners with operations and other support teams to ensure quality, integrity in services, stability, and process efficiency in operations through inspection, auditing, and collaboration. Ensures adherence to audit schedules. Communicates audit results and trends with local managers, upline management, and corporate departments. Provides education during the audit process and makes recommendations for development or revision to policy, process, education, best practices, etc. based on audit results. Ensures that the audit itself is updated and measures service quality, fosters compliance with internal and external requirements, and provides education for field operations regarding requirements and the audit process.

    Responsibilities

    • Develops and implements the auditing policies and procedures• Participates in meetings with internal departments to gather information and ensure that the audit/assessment tools continue to measure critical indicators of success and address audit/company objectives• Ensures continuous learning and development of skillsets needed to perform a comprehensive quality audit and provide required direction to the audit team as well as field operations to improve performance• Oversees and ensures that the audit is completed for all applicable operations at the frequency determined (after baseline is established, a frequency is determined based on prior audit performance)• Completes audits, provides education for operations staff regarding requirements and audit process, and meets targets for reviews• Ensures that the quality audit tools are updated and measure service quality and fosters compliance with internal and external requirements • Communicates audit results/trends to operations managers/leadership, operations support team, and any/all pertinent corporate departments• Makes recommendations for revisions in policy/education/training• Reviews and prepares written reports to communicate observations and redesign recommendations• Facilitates compliance with corporate policies and legal requirements and reports audit findings that would put the company at risk to senior management and the Chief Compliance Officer and/or Legal Department• Works with regional operations and quality leadership to identify priorities, determine operational needs, and recommend actions to drive improvement• Provides expertise regarding policy interpretation, process improvement, and follow-up actions required• Uses data from additional sources such as audits, Critical Incidents, Satisfaction Surveys, and regulatory reviews to prioritize operations for audit and guide recommendations for revision to quality improvement goals and objectives• Reinforces the consistent utilization of the company’s risk management systems to maximize the safety and security of employees and those receiving services• Maintains expert knowledge related to accreditation standards, compliance and regulatory requirements, and review processes• Supports operations to provide services in an ethical and lawful manner• Keeps abreast of all company policies and procedures, local, state, and federal laws and regulations, and applicable accreditation standards• Accountable to proactively identify issues and request assistance up-line as indicated• Ensures and coordinates communications and information between corporate departments, field operations, and the quality audit team • Participates in special projects and performs related duties as assigned

    Qualifications

    • Bachelor’s Degree in human services, education, social work, nursing, or a related field required• 3-5 years prior work experience in Community Living, HomeCare required• Prior experience in conducting audits/quality reviews preferred• Must be able to work independently• Requires excellent written and oral communication skills• Proven ability to manage multiple priorities• Working knowledge of regulatory requirements for assigned Line of Business• Excellent computer skills including Microsoft Word, Excel, and PowerPoint• Must be willing to work flexible hours• Requires up to 100% travel across multiple states• Reviews will be completed in the operations to include residential homes, day programs, host/foster family homes, client homes, and offices• Remote work such as electronic record reviews, developing reports, and preparation can be completed at home offices

    About our Line of Business

    BrightSpring Health Services is a leading provider of complementary home and community-based pharmacy and health services for complex populations in need of chronic and/or specialized care. Through the company’s pharmacy and provider services to seniors and specialty (including behavioral) populations, we provide comprehensive care and clinical services in 50 states to over 360,000 customers, clients and patients daily. The company’s services foster greater patient and family satisfaction, improve outcomes and reduce health care system costs, and are supported by industry-leading quality outcomes. For more information, visit www.brightspringhealth.com. Follow us on Facebook, Twitter and LinkedIn.

    Salary Range

    USD $65,000.00 - $75,000.00 / Year
  • 23 Days Ago

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Quality Audit Coordinator
  • McCain Foods USA, Inc.
  • Othello, WA FULL_TIME
  • Position Title: Quality Audit Coordinator Position Type: Regular - Full-Time Position Location: Othello Requisition ID: 28747 McCain Foods USA Job Description/Job Safety Analysis Othello Factory Job T...
  • Just Posted

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Quality Audit Coordinator
  • McCain Foods
  • Othello, WA FULL_TIME
  • Position Title: Quality Audit Coordinator Position Type: Regular - Full-Time Position Location: Othello Requisition ID:28747McCain Foods USA Job Description/Job Safety Analysis Othello Factory Job Tit...
  • 2 Days Ago

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Director of Internal Audit
  • Itron
  • Liberty, WA FULL_TIME
  • Itron, located in Liberty Lake, WA, is recruiting a Director of Internal Audit to lead our internal audit team. This position reports to the CFO. The Director of Internal Audit will work with the busi...
  • 1 Month Ago

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Complex Claims Director
  • Berkshire Hathaway Specialty Insurance
  • Seattle, WA FULL_TIME
  • Who are we? A strong, trusted insurance partner, Berkshire Hathaway Specialty Insurance (BHSI) provides a broad range of commercial property, casualty and specialty insurance coverages and outstanding...
  • Just Posted

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Director of Quality
  • Sila Nanotechnologies
  • Moses Lake, WA FULL_TIME
  • About Us We are Sila, a next-generation battery materials company. Our mission is to power the world's transition to clean energy. To create this future, our team is building a better lithium-ion batt...
  • 21 Days Ago

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Director of Quality Control
  • Theery
  • Skokie, IL
  • our client is seeking a dynamic and experienced leader to join their team as the Leader of Quality Control. In this role...
  • 3/27/2024 12:00:00 AM

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Director of Quality Control
  • ADAGE INNOVATIONS INC
  • Alexandria, VA
  • Job Description Job Description Benefits/Perks Competitive Compensation Great Work Environment Career Advancement Opport...
  • 3/27/2024 12:00:00 AM

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Director of Quality Control
  • Virbac
  • Bridgeton, MO
  • Experiencing together a unique human adventure Animal health is key to the health of the planet. Working at Virbac means...
  • 3/27/2024 12:00:00 AM

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Associate Director of Quality Control
  • Sern BioScience
  • Bend, OR
  • The Quality Control department seeks an industry leader who demonstrates strong regulatory knowledge and GMP standards t...
  • 3/27/2024 12:00:00 AM

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Director of Quality Control
  • Direct Biologics
  • San Diego, CA
  • Direct Biologics is a market leading innovator and science-based cGMP manufacturer of regenerative biologic products. We...
  • 3/26/2024 12:00:00 AM

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Director of Quality Control/Training
  • Green Home Solutions
  • Mount Airy, MD
  • If you've got an eye for detail, an aptitude for solving problems, and a drive to make sure that you and your teammates ...
  • 3/26/2024 12:00:00 AM

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Director of Quality Control
  • Careerbuilder
  • Decatur, IL
  • The Head of Quality Control will be an instrumental part in the re-opening of our Manufacturing facility in Decatur, Ill...
  • 3/25/2024 12:00:00 AM

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Director of Quality Management
  • Select Specialty Hospital - The Villages
  • Oxford, FL
  • Overview: Critical Illness Recovery Hospital Director of Quality Management At Select Specialty/Regency Hospitals, a div...
  • 3/25/2024 12:00:00 AM

Washington (/ˈwɒʃɪŋtən/), officially the State of Washington, is a state in the Pacific Northwest region of the United States. Washington is the northwestern-most state of the contiguous United States. It borders Idaho to the east, bounded mostly by the meridian running north from the confluence of the Snake River and Clearwater River (about 116°57' west), except for the southernmost section where the border follows the Snake River. Oregon is to the south, with the Columbia River forming the western part and the 46th parallel forming the eastern part of the Oregon-Washington border. To the wes...
Source: Wikipedia (as of 04/17/2019). Read more from Wikipedia
Income Estimation for Claims Quality Audit Director jobs
$162,202 to $231,802

Claims Quality Audit Director in Olympia, WA
Based on our compensation data, the estimated salary potential for Claims Quality Audit Director will increase 16 % over 5 years.
December 23, 2019