Physician QA Manager

Summary

C2 ALAKSA, LLC

Telework

The Medical Quality Assurance Manager shall train and report on the work progress of qualified personnel referred to as Medical Consultants (MCs) who will provide quality assurance of medical reviews and assessments on disability cases in the specialties of General Medicine or Internal Medicine for the Social Security Administration (SSA).

Responsibilities

• Administration
• Keep current on SSA policy and medical research for successful reviews of medical assessments.
• Attend required meetings, briefings, and workgroups necessary to perform independent case reviews (e.g., policy updates, procedural changes) or to discuss administrative issues related to the contract.
• Respond to all communications including instant message or email.
• Participate in presentations, as needed;
• Provide consultation and expertise on policy development issues including written and/or oral summarizations;
• In the PCQAM’s absence, the MCQAM will support the PCs.
• Participate in workgroups, visits, and meetings as requested by SSA to discuss issues related to the disability process; e.g., new medical technologies, revision of medical listings, and other policy issues (this does not include meetings, briefings, or workgroups necessary for independent case reviews); and
• Other Duties as assigned.
• Quality Assurance Management
• Review trainee case adjudications for quality assurance.
• Review a percentage of Independent Case Reviewer (ICR) case adjudications for quality assurance.
• Quality assurance reviews must uphold the requirements for a policy compliant review as per the Independent Case Reviewer certification requirements of C2 Alaska, LLC.
• Consult with staff and others (e.g., other MCs/PCs, medical providers, or Medical Advisors) as needed for the review of the case.
• Ensure findings are recorded in the agency electronic processing systems as specified by SSA case review policies and procedures.
• Ensure satisfactory written assessments are free of spelling and grammatical errors that can be used by others in the disability program.
• Review all medical and non-medical evidence of record; including any prior file information.
• Request additional evidence, only when the evidence in the file is insufficient to assess in accordance with current SSA disability policies and procedures.
• Ensure composition of medical assessments (or opinions) are in a professional manner, in a formal tone (third person), free of jokes, personal anecdotes, emotion, biases, prejudices or colloquial expressions.
• Review and assess written independent narrative conveys individualized review in a clear and concise manner.
• Provide remediation for identified quality errors.
• Ensure independent case reviews are completed within time frames established by the COR.
• Track and monitor all MC case assignments for timely completion and identify cases that require reassignment.
• Ensure required corrections are made to medical assessments when returned from the Office of Quality Review (OQR).
• Report suspected fraud identified in the course of the medical assessment.
• Training
• Facilitate, conduct, monitor, and participate in training activities with MCs.
• Provide insight and guidance to MCs for ongoing training and offer consultative support for initial training and orientation.
• Assign cases to MCs in training and orientation.
• Provide retraining opportunities as needed.
• Other duties as assigned.
  
  

Qualifications

• Doctorate of Medicine or Osteopathy from an accredited college approved by the Council of Medical Education and Hospitals of the American Medical Association or Doctor of Osteopathy from a college accredited by the American Osteopathic Association
• Possess and maintain a Valid unrestricted license to practice medicine within one of the 50 states, the District of Columbia, Puerto Rico, or the U.S. Virgin Islands
• Minimum three (3) year experience practicing medicine within the last seven (7) years in one of the following specialties: Internal Medicine OR General Medicine
• Minimum one (1) year of experience with SSA Title 2 and Title 16 programs as an Independent Case Reviewer
  
  
  

Knowledge, Skills And Abilities

• Ability to organize and effectively administer training covering complex and technical content to professionals.
• Ability to read, write, and speak English well enough to effectively communicate with all parties and other health care providers.
• Shall be computer literate.
• Knowledge of the required education, training, experience, and documented current competence in the required specialty position description.
• Possess sufficient initiative, interpersonal relationship skills and social sensitivity such that he/she can relate constructively to a variety of patients from diverse backgrounds.
• Possess sufficient initiative, interpersonal relationship skills and social sensitivity such that he/she can relate constructively to a variety of patients from diverse backgrounds.
• Exceptional organizational and time management skills with the ability to navigate multiple duties/responsibilities.
• Ability to write in a clear, concise, grammatically correct manner.
• Knowledge and excellent computer skills including the use of computer software applications for drafting documents, data management, and tracking. This includes competency with Microsoft Office (Word, Excel, Outlook, PowerPoint).
  
  
  

Physical Demands (The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.)

• While performing the duties of this Job, the employee is regularly required to sit and talk or hear. The employee may use repeated motions that include the arms, wrists, hands and/or fingers. The employee is occasionally required to walk, stand, climb, balance, stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision.
  
  
  

Teleworking Permitted?

Yes

Teleworking Details

100% Remote

Estimated Salary/Wage

USD $225,000.00/Yr. Up to USD $250,000.00/Yr.