QA External LTSS Oversight Professional - Remote

Overview

The Quality Assurance Professional reviews LTSS contractor documentation and performance to ensure compliance with contract scope of work, and state and federal regulations. This role involves conducting compliance audits, analyzing data, and ensuring adherence to policies and procedures.

In Short

• Review LTSS contractor documentation and performance.
• Conduct compliance audits and summarize reports.
• Analyze data trends and operational metrics.
• Ensure adherence to state and federal regulations.
• Work independently and with a team.
• Communicate findings with leadership.
• Occasional travel for meetings or audits.
• Proficient in Microsoft Office products.
• Minimum of 2 years’ experience in LTSS.
• Bachelor’s degree in social work or nursing (unlicensed).

Requirements

• Must reside in Michigan or within 40 miles of the border in Indiana or Ohio.
• Experience with Managed Care Organization.
• Exceptional oral and written communication skills.
• Ability to work independently under general instructions.
• Licensed healthcare professional preferred (LPN, RN, LSW, LISW).
• Experience with Medicare/Medicaid, MDHHS, CMS, and NCQA preferred.

Benefits

• Competitive benefits including medical, dental, and vision.
• 401(k) retirement savings plan.
• Paid time off and holidays.
• Short-term and long-term disability insurance.
• Life insurance and other opportunities.