Comagine Health provides a broad range of services for the District of Columbia, Department of Health Care Finance (DC Medicaid). Our regional office in the District is staffed by people who live in and around the District and whose work helps improve and advance the efficiency, economy, effectiveness and quality of healthcare services provided to enrolled District of Columbia Medicaid clients. Services we provide include:
- Prior authorization review
- Pre-admission review
- Emergency admission review
- Continued stay review
- Retrospective review
- Long term care review
Reporting to our Project Director, you would oversee clinical and non-clinical operations, ensuring fulfillment of all required contractual, legal, and accreditation standards plus compliance with corporate and Care Management policies. Typical responsibilities include:
- Contributes to, implements, and maintains departmental policies and procedures, staffing protocols, and training programs.
- Manages continuous quality improvement initiatives to improve the delivery, quality, and effectiveness of Comagine Health’s service delivery.
- Monitors the reliability and consistency of teams' work output to ensure adherence to contract deliverables; collaborates with the Project Director to effectively and timely address issues that are identified.
- Attends monthly performance meetings with the District’s contracting officer’s representative; provides feedback on the findings of the monitoring activities, identifies opportunities for performance improvement, and steps that must be taken to implement initiatives or complete corrective action.
- As needed, may also conduct utilization management reviews, plus other case reviews.
Required Skills
- BA / BS in a related field (equivalent combination of education and/or work experience may be substituted).
- MA / MS in a related field preferred.
- Current, active, unrestricted RN licensure in D.C.
- Willing to work onsite in D.C. (Metro Center).
Required Experience
- 3+ years of Medicaid-specific UR and QA experience (with MA or MS), or
- 5+ years of Medicaid-specific UR and QA experience (with BA or BS).
- Proficiency with utilization review, community-based programs, quality assurance / improvement, and Medicaid.
- Supervisory and/or management experience.