Now is the Time to Join Us!
Ready to create a healthier world? We are ready for you! Personify Health is on a mission to simplify and personalize the health experience to improve health and reduce costs for companies and their people. At Personify Health, we believe in offering total rewards, flexible opportunities, and a diverse inclusive community, where every voice matters. Together, we’re shaping a healthier, more engaged future.
ResponsibilitiesWho are you?
Responsible for overseeing quality systems and regulatory compliance within state, federal, and accreditation bodies. Through standard operating procedure review and internal audits, they are responsible for identifying discrepancies, ensuring adherence to clinical policies, and safeguarding the reliability of clinical data. They collaborate closely with clinical teams, regulatory bodies, and accreditors. The specialist’s focus is continuous clinical improvement and regulatory excellence.
In this role you will wear many hats, but your knowledge will be essential in the following:
Ensures compliance with state, federal, NCQA, and URAC standards.Conduct internal and external audits of clinical programs.Prepare and present quality assurance reportsMonitor clinical trial activities to ensure adherence to protocolsTrain clinical staff on regulatory requirements and quality standardsAssists with staff training materials and software development to ensure use of up-to-date evidence-based resources.Identify and manage risks related to clinical qualityReview and approve Standard Operating ProceduresCollaborate with cross-functional teams to resolve quality issuesMaintain up-to-date knowledge of industry standards and regulationsStay current with evidence-based practice models and current processes to provide staff instruction.Other related duties as assigned to meet departmental and Company objectivesAttend and participate in all mandatory department and training meetings as assigned by management.Comfort level in Microsoft suite and Smart SheetParticipates in case file preparation and mark-up for auditAbility to pass external audits to include URAC and NCQA.Maintain HIPPA compliance per company’s policy and procedures.Maintain confidentiality and minimum requirement rules.Complete all required yearly training per company’s expected period.You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
QualificationsWhat you bring to the Personify Health team:
In order to represent the best of what we have to offer you come to us with a multitude of positive attributes including:
Holds an active unrestricted Registered Nursing LicenseBachelor’s Degree preferred2-4 years UR, CM, DM experience requiredManaged care experience preferredYou also take pride in offering the following Core Skills, Competencies, and Characteristics:
Basic computer literacyExcellent analytical and problem-solving skillsExceptional attention to detailThe ability to work on multiple screens, and proficient typing skills.Proficiency in software applications including, but not limited to, Microsoft Word, Microsoft Excel, and Outlook Excellent verbal and written communication skillsAbility to speak clearly and convey complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others.Ability to work independently and utilize written resources to problem solve.After training with our training department and 1.5 months ramp (3 months total), must have and be able to work in:Teams on and off camera, SharePoint, Drives as needed, VPN, UM Web or Health Notes, El Dorado, Quick Links, GIAS, ADP, Confluence, Phone system with headset, Smartsheet—there may be additional programs as it relates to particular job dutiesKnowledge of medical claims and ICD-10, CPT, HCPCS codingExcellent verbal and written communication skills for upward and downward conversationsNo candidate will meet every single desired qualification. If your experience looks a little different from what we’ve identified and you think you can bring value to the role, we’d love to learn more about you!
Personify Health is an equal opportunity organization and is committed to diversity, inclusion, equity, and social justice.
In compliance with all states and cities that require transparency of pay, the base compensation for this position ranges from $36.00 to $38.00 per hour. Note that compensation may vary based on location, skills, and experience. This position is eligible for [x%] target bonus/variable compensation as well as health, dental, vision, mental health and other benefits.
We strive to cultivate a work environment where differences are celebrated, and employees of all backgrounds are empowered to thrive. Personify Health is committed to driving Diversity, Equity, Inclusion and Belonging (DEIB) for all stakeholders: employees (at each organization level), members, clients and the communities in which we operate. Diversity is core to who we are and critical to our work in health and wellbeing.
#WeAreHiring #PersonifyHealth #TPA #HPA #Selffunded
Beware of Hiring Scams: Personify Health will never ask for payment or sensitive personal information such as social security numbers during the hiring process. All official communication will come from a verified company email address. If you receive suspicious requests or communications, please report them to talent@personifyhealth.com. All of our legitimate openings can be found on the Personify Health Career Site.
Application Deadline: Open until position is filled.
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