Market Clinical Quality Specialist

Title: The Market Clinical Quality Specialist ALTA is supporting a 3-month contract opportunity working 100% remote. 2 roles are open. The ideal candidate should have clinical experience/background: RN, Social Worker, LPN or Medical Assistance. ALTA IT Services is a wholly owned subsidiary of System One, a leading provider of specialized workforce solutions and integrated services. ALTA is an established leader in IT Staffing and Services, for both government and commercial enterprises across the United States, specializing in Program & Project Management, Application Development, Cybersecurity, Data & Advanced Analytics, and Agile Transformation Services. The Market Clinical Quality Specialist II completes assigned case/file reviews to ensure adherence to regulatory requirements and identified Standard Operations Procedures (SOPs). Essential Functions:

Ensure compliance with adherence to regulatory requirements and identified Standard Operating Procedures (SOPs) through monthly inter-rater reliability monitoring of case reviews

Identify departmental training and development opportunities and work collaboratively with peers and Care Management to develop the needed education and/or training

Assist Management with reporting of case reviews that can be communicated at overall aggregate and individual contributor levels

Subject matter expert (SME) in assigned area(s)

Participate in interdepartmental meetings/workgroups, as directed, to ensure that new operational procedures and updates to existing procedures for Care Management (CM) are compliant with contract requirements

Provide cross-functional assistance to meet monitoring, accreditation and operational responsibilities to ensure adherence to regulatory requirements

Maintain familiarity with all applicable Federal and State Requirements, which include the Corporate Integrity Agreement responsibilities; also responsible for monitoring changes within those requirements, identifying the areas that will be impacted, communicating the changes and assisting with implementation of the changes

Continuously pursue and identify best practices as well as opportunities for improvement and facilitate implementation of improvement initiatives for health services monitoring and accreditation

Perform any other job-related instructions as requested

Education and Experience:

Associate of Science in Nursing (ASN) is required

Bachelor of Science in Nursing (BSN) is preferred

One to three (1 to 3) years of experience in Quality Improvement, Project Management, Case Management or Utilization Review is required

Minimum of three (3) years of diverse clinical experience as an RN is preferred

Competencies, Knowledge and Skills:

Intermediate in Microsoft Excel, Access and Word

Intermediate skill level with SharePoint

PowerPoint and Visio preferred

Strong written and verbal communication skills Ability to work independently and within a team environment

Familiarity of the healthcare field

Knowledge of Medicaid and Medicare

Effective listening and critical thinking skills

Strong interpersonal skills and high level of professionalism

Effective problem-solving skills with attention to detail

Ability to develop, prioritize and accomplish goals

Technical writing skills

Ability to coordinate complex projects and multiple meetings

Ability to work with a variety of disciplines and levels of staff across departments

Licensure and Certification:

Current, unrestricted Registered Nurse (RN) licensure in state of practice, is required

Case Management Certification, such as Certified Case Manager (CCM) through the Commission for Case Management Certification (CCMC), is highly preferred

Working Conditions:

General office environment; may be required to sit or stand for extended periods of time

For immediate consideration, please apply directly or contact Patrick Jackson at pjackson@altaits.com.

System One, and its subsidiaries including Joulé, ALTA IT Services, CM Access, TPGS, and MOUNTAIN, LTD., are leaders in delivering workforce solutions and integrated services across North America. We help clients get work done more efficiently and economically, without compromising quality. System One not only serves as a valued partner for our clients, but we offer eligible full-time employees health and welfare benefits coverage options including medical, dental, vision, spending accounts, life insurance, voluntary plans, as well as participation in a 401(k) plan.System One is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, age, national origin, disability, family care or medical leave status, genetic information, veteran status, marital status, or any other characteristic protected by applicable federal, state, or local law.