Position Title: Intake Care Lead Analyst
Work Location: Remote
Assignment Duration: 3 Months
Position Summary
Provides support to Quality of Care team activities. Assigns quality of care (QOC) cases to Quality of Care unit Registered Nurses for review, investigation and resolution.
Serves as initial contact with providers and facilities when requesting medical records for QOC cases.

Key Responsibilities
• Utilizing QNXT to ascertain if a provider is par vs. non-par
• Communicating with the Grievance Administration Division (GAD) team to clarify complaints or obtain additional information
• Posting cases to the QOC spreadsheet
• Assigning cases to the QOC nurses
• Creating case files
• Requesting medical records and posting received records to case files
• Assisting QOC nurses with completion of QOC resolution letters
• Maintaining all QOC letter templates and job aids
• Interfacing with providers and facilities in obtaining medical records
• Utilizing CCMS to obtain QOC case information
• Providing weekly and monthly reports
• Maintaining QOC email box
• Managing incoming faxes
• Taking meeting notes and distributing minutes
• Maintaining QOC nurse worksheets
• Assisting in preparation and management of Quality of Care reports
• Maintaining performance against established targets

Qualification & Experience
• Three plus years of quality review and improvement experience required
• Two plus years of relevant experience within Quality Management and/or Grievance processes
• Experience with CMS, NCQA standards, HEDIS, CAHPS, HOS and quality management preferred
• Knowledge/experience in the Medicare/Medicaid industry preferred
• Strong knowledge of patient disease processes
• Thorough knowledge of medical terminology
• Strong analytical and problem-solving skills
• Strong interpersonal and communication skills
• Intermediate Microsoft Word, Excel, PowerPoint and Outlook skills
• Ability to maintain confidentiality
• Ability to work independently and meet deadlines

 
 
At SPECTRAFORCE, we are committed to maintaining a workplace that ensures fair compensation and wage transparency in adherence with all applicable state and local laws. This position’s starting pay is: $ 25.88/hr.