Full-Time Health Services Quality Coach (Remote Eligible)

• About the role: As an integral partner in upholding Wellmark’s compliance and consistency within utilization management and case management processes, you will be responsible for auditing the work of both clinical and non-clinical team members in support of Wellmark’s business portfolio, including FEP.
• Your primary focus will be to support internal and external performance metrics by auditing, researching, reporting, and analyzing Health Services activities to ensure alignment with established standards, policies, and procedures.
• You will deliver individualized and group coaching to guide team members in achieving and surpassing company and FEP expectations and metrics.
• Serving as an expert in Wellmark’s clinical quality assurance review, you will identify and recommend improvements to Health Services procedures and ensure accurate documentation of processes.
• Building strong relationships and credibility within the organization will be critical to your success in this role.

• What you will do:
• Assess and evaluate the accuracy of file documentation for complex Health Services processes.
• Perform audits, research, and analysis to support department metrics targets, QA score expectations, and ensuring compliance with regulatory, accreditation, FEP and OPM requirements.
• Research issues identified in quality reviews by performing additional investigation into operational procedures.
• Generate reports and create documents that communicate results of analysis, research, and metrics to demonstrate trends, changes, and results of projects and activities.
• Generate and ensure accurate, timely reporting of quality measurements for leadership and business partners.
• Collaborate with department leaders on individual or team performance or process improvement plans.
• Support the measurement of outcome and success metrics for Health Services.
• Collaborate with department trainer(s) in cross-training team members on procedures and guidelines for Health Services functions.
• Document and update quality review and procedural documents with edits and revisions as changes in guidelines or regulations occur.
• Serve as a business resource and subject matter expert (SME) for FEP process, reporting and letter requirements.
• Assist in investigation of quality of care, quality of service and department inquiry and complaints as needed.
• Participate in FEP pilots and/or projects as needed.

What is the last date for applying to the job?

Which countries are accepted for this remote job?