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Quality Review Specialist III

Qlarant

Role overview

Qualifications

  • Minimum Bachelor's Degree required
  • 5 - 7 years of experience required; 8 - 11 years preferred
  • Must meet the criteria to be a Developmental Disabilities Professional (DDP)
  • Must meet the criteria to be a Qualified Intellectual Disabilities Professional (QIDP)

Responsibilities

  • Facilitates routine evaluations to assess the extent to which individuals with intellectual developmental disabilities (IDD) are receiving customized support and services.
  • Performs scheduled reviews to assess how effectively IDD service providers are preserving the health and safety of individuals.
  • Assists management in identifying areas for improvement in service delivery and collaborates with service providers to implement continuous improvements.
  • Analyzes data related to program outcomes and client satisfaction to inform decision-making.

Key facts

Hard skills

Quality Assessment Program Evaluation Report Generators Stakeholder Communications

Other skills

  • Training And Development
  • Advocacy
  • Problem Solving
  • Communication

About the company

Qlarant logo

Qlarant

IT Services & IT Consulting

For 49 years, our history has been rooted in commitment to quality improvement for organizations — and quality of life for the people they serve. We began as Delmarva Foundation for Medical Care in 1973 on Maryland’s Eastern Shore as one of the country’s first quality review organizations for the Centers for Medicare and Medicaid. Through the decades, we created entities that became nationally known, including Delmarva Foundation, Health Integrity, and Quality Health Strategies. Today, we’ve brought together these extensive resources and the expertise of more than 500 professionals under one name — Qlarant — serving some of our nation’s most important programs in health, human services, government and insurance & financial services. Qlarant has a strong commitment to protecting the integrity of national and state health care systems in Medicare, Medicaid, and the private sector. In addition, The Qlarant Foundation issues annual grant awards to various programs that provide programs to underserved communities. Qlarant offers a broad range of innovative services: we’re proud to deliver our solutions for Quality Improvement; Fraud, Waste, & Abuse; and Data Sciences & Technology. Our Real-time Predictive Modeling and Data Analytics tools sift through billions of claims and public criminal records to detect aberrant trends and alert users for early investigative and audit actions with high accuracy and performance. We also provide quality review programs, auditing, training, and have an in-house call center ready to meet your needs. Visit www.qlarant.com for further information.

Company details

Company typeLarge
IndustryIT Services & IT Consulting
Company size501 - 1000

Links

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Job description

Qlarant is a not-for-profit corporation that partners with public and private sectors to create high quality, safe, and efficient delivery of health care and human services programs. We have multiple lines of business including population health, utilization review, managed care organization quality review, and quality assurance for programs serving individuals with developmental disabilities. Qlarant is also a national leader in fighting fraud, waste and abuse for large organizations across the country. In addition, our Foundation provides grant opportunities to those with programs for underserved communities.

Best People, Best Solutions, Best Results

Job Summary:

Facilitates routine evaluations to assess the extent to which individuals with intellectual developmental disabilities (IDD) are receiving customized support and services tailored to their unique needs and specific situations. Performs scheduled reviews to assess how effectively IDD service providers are in preserving the health and safety of the individuals in their care. Assists management in identifying areas for improvement in service delivery, providing technical assistance, generating meaningful recommendations, and collaborating with service providers to execute continuous improvements that meet the needs of individuals with developmental disabilities.

Essential Functions:

  • Administers detailed evaluations of programs and service providers to assess their effectiveness and adherence to established standards. 
  • Ensures that programs comply with relevant laws, regulations, and policies related to developmental disabilities. 
  • Determines areas for improvement in programs and services and works with stakeholders to implement quality enhancement initiatives. 
  • Inspects documentation, reports, and records to providers to ensure that their needs are met in a respectful and prudent manner. 
  • Advocates for the rights and well-being of individuals with developmental disabilities and ensures that their needs are met in a respectful and person-centered manner. 
  • Analyzes data related to program outcomes, client satisfaction, and other relevant metrics to inform decision-making and continuous improvement efforts. 
  • Communicates with service providers, agencies, and stakeholders involved in providing services to individuals with developmental disabilities.
  • Develops and provides technical assistance, training and guidance to staff and service providers on best practices, quality standards, and compliance requirements. 
  • Exercises professional judgment and takes immediate action in the case of abuse, neglect, and/or exploitation by following established protocols. 
  • Conducts interviews with individuals receiving services and provider staff in a respectful manner. 
  • Documents accurate review findings and generates reports based on the results.

Level of Supervision Received:
Plans and arranges own work; works with manager to prioritize projects

Education (can be substituted for experience):
Minimum Bachelor's Degree required

Work Experience (can be substituted for education):
5 - 7 years of experience required; 8 - 11 years preferred

Certification(s):
Must meet the criteria to be a Developmental Disabilities Professional (DDP) and Qualified Intellectual Disabilities Professional (QIDP)

Qlarant is an Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities.

Qlarant is a drug-free workplace. All offers of employment are contingent upon successful completion of pre-employment background and drug screens.

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MR

Marcus Rivera

Chief Revenue Officer

m.rivera@company.com
linkedin.com/in/marcusrivera
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