Job Description

Spherion, in partnership with the State of Wisconsin Department of Health Services, is looking for a quality-driven, customer-focused Quality Assurance Program Specialist! This position will work on a major Medicaid-funded program that delivers long-term care to Wisconsin's eligible population of adults with disabilities and frailties of aging. The Quality Assurance Program Specialist will participate in the development and implementation efforts related to objective monitoring and improvement of the quality-of-care performance of the IRIS program.

THE PTO/PAID HOLIDAY POLICY FOR THIS POSITION MIRRORS THE POLICY OF THE STATE OF WISCONSIN!

REMOTE/ONSITE HYBRID MODEL!

RESPONSIBILITIES:

• The review of the IRIS budget amendment (BA) and one-time expense (OTE) requests
• Remediation of Background check appeals
• Reimbursement file review
• Monitoring and tracking Fair hearing appeals and grievances
• Participation in the review of Restrictive Measures requests and the review and approval of designated waiver services prior to plan approval
• Compile, aggregate, and analyze the results of the budget amendment and onetime expense requests for quality and process improvement
• Represent the department at meetings attended by representatives of the long-term care industry or other special interest groups. Conduct/facilitate workshops and make presentations to such groups relative to the record review process and/or findings
• Other duties as needed

SKILLS & QUALIFICATIONS:

• Bachelor's Degree preferred
• Family care or Medicare background required
• Knowledge of the state and federal statutes, regulations, policies, and procedures governing the Medical Assistance program
• Knowledge of quality improvement and assurance methods and tools
• Comprehensive understanding of protected health information, HIPAA requirements, and confidentiality principles
• Demonstrated computer and software skills including proficiency with Microsoft Office Suite
• Excellent written, verbal, and listening communication skills
• Strong organizational and time management skills
• The ability to work independently and also cooperatively as part of a team
• Flexibility in the work environment and willingness and ability to adapt to changing organizational needs

Company Description

Since 1946, Spherion has placed millions of talented individuals in rewarding administrative, clerical, light industrial, customer service, non-clinical healthcare and professional jobs. Filling a broad mix of flexible, temp-to-hire and direct hire positions, Spherion is a trusted recruiting and staffing partner to more than 3,000 companies nationwide.