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Supervisor, Quality Review - San Antonio, TX

UnitedHealth Group


Location:
San Antonio, TX
Date:
05/23/2017
Job Code:
1740076
Apply on the Company Site
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Job Details


Supervisor, Quality Review - San Antonio, TX(Job Number:710910)
Description

Expanding access to affordable, high quality health care starts here. This is where some of the most innovative ideas in health care are created every day. This is where bold people with big ideas are writing the next chapter in health care. This is the place to do your life's best work.(sm)

 

The Quality Review Supervisor is responsible for coordinating efforts and workflow for all areas of audit team, including data entry, claims, and customer service. This position requires oversight and direct supervision of the individual staff as well as overall team performance to include daily workflow, monthly metrics, and individual monthly / annual evaluations of staff. The Quality Review Supervisor ensures all audits are completed timely, oversee rebuttal process and coordinates scorecard reporting for each audit area.  Additionally, the quality review supervisor will facilitate bi weekly meetings for each audit area and will partner with various departments to identify root cause & analysis and pertinent feedback to drive quality in a positive direction.  The Quality review supervisor will be responsible for reporting results, error trends, feedback on training needs, and impact to overall performance to the Quality director.

 

Primary Responsibilities:

  • Supervises assigned personnel to ensure audits are conducted using related guides and training materials
  • Monitors audit priority, workflow, and schedule to ensure productivity standards are met
  • Monitors employee performance to include but not limited to production and quality monthly and annually
  • Evaluates performance and recommends merit increases, promotions, and disciplinary actions, assists in interviews, trains, and orients staff
  • Approve time cards; coordinate time- off requests while evaluating business needs
  • Ensures audit staff understands current information and updates on claims payment, provider / contract configuration, customer service, and benefit configuration processes
  • Acts as a resource to auditors and internal business partners for the purposes of training or trouble shooting for continuous process improvement
  • Effectively plan staff responsibilities and manage activities daily, utilizing staff resources to meet departmental goals including seeking out assistance when needed
  • Review monthly scorecards for accuracy and low / high performance trends
  • Stay abreast of industry standards, CMS guidelines and ongoing trends that would impact the department
  • Communicate well with Director, Interdepartmental Management, Senior leadership, and assist management with additional duties or projects that are assigned
  • Supports staffing initiatives by screening, interviewing and selecting new employees for current job vacancies
  • Performs all other related duties as assigned

 


Job Provider Contract Installation
Primary Location US-TX-San Antonio
Other Location 
Organization WellMed Medical Mgmt, Inc
Schedule Full-time
Number of Openings 1
Apply on the Company Site

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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