Providence Health & Services Quality Medical Management Technician in Beaverton, Oregon
Providence St. Joseph Health is calling a Quality Medical Management (QMM) Technician to our location in Beaverton, OR.
We are seeking a Quality Medical Management (QMM) Technician to be responsible for providing services for and improving the quality and productivity of the Quality Medical Management Department in one or more of the core functional areas of case management, concurrent review, prior authorization, appeals, medical audit and/or training. The work focuses on technical and analytical support and/or the organization and coordination of one or more functional area support activities; analysis of service, production and/or program outcomes against policies, standards and objectives; and the development of training and documentation for process and performance improvement. The QMM Technician uses a global approach to assure core activities and functional areas are integrated and linked to achieve the highest outcomes for our customers. This approach will result in improved quality of care and service, and higher customer and employee satisfaction.
In this position you will have the following responsibilities:
Proficient in the principle duties or functions of one or more core Utilization Management Program or Quality Medical Management Department functional areas.
Perform duties or functions of a core program (as assigned) according to established guidelines and analyze and prepare summary of results as requested. Work with Manager/Director to develop corrective action plans as needed to improve outcomes.
Act as a resource and provides technical assistance to the nursing staff and medical directors on member contracts, claims payment procedures, coding systems, claims research, database management and department operating procedures.
Research pended claims and authorizations for appropriate payment determination based on assessment of complex information, such as contract language, provider status, payment guidelines, risk designation and system setup.
Enter data and manages databases as required for management and support of programs and core functions.
Train or re-train staff as necessary based on expertise, experience, action plans, external changes, or demands (regulatory or product).
Work with peers and others to resolve service or production problems.
Develop or revise, or assist to develop or revise, department or unit policies, procedures, or work flows.
Serve as a department liaison and resource to members, providers, and other PHP departments on QMM programs or functions, projects, activities, training and problem resolution.
Participate on or leads work teams or project teams according to expertise and as assigned.
Coordinate with internal and external entities and departments to assure accurate and timely provision of service to customers.
Participate in peer reviews as requested by Manager/Director.
Required qualifications for this position include:
H.S. Diploma or GED.
3 years health insurance experience.
Experience as lead or team member on a project team.
Experience in database management and spreadsheets.
Current state registration, license, or certification as appropriate to education.
Preferred qualifications for this position include:
Bachelor's Degree or 5 years of work experience in related field.
2 years business environment experience
Experience in a utilization management functional area such as case management, concurrent review, prior authorization, medical audit, appeals or delegation.
About Providence in Oregon.
As the largest healthcare system and largest private employer in Oregon, Providence offers exceptional work environments and unparalleled career opportunities.
The Providence Experience begins each time our patients or their families have an encounter with a Providence team member and continues throughout their visit or stay. Whether you provide direct or indirect patient care, we want our patients to feel that they are in a welcoming place where they can be comfortable and free from anxiety. Our employees create the Providence Experience through simple, caring behaviors such as acknowledging and welcoming each visitor, introducing ourselves and Providence, addressing people by name, providing the duration of estimated wait times and updating frequently if timelines change, explaining situations in a way that puts patients at ease, carefully listening to their concerns, and always thanking people for trusting Providence for their healthcare needs. At Providence, our quality vision is simple, "Providence will provide the best care and service to every person, every time."
Providence is consistently ranked among the top 100 companies to work for in Oregon. It is also home to two of our award-winning Magnet medical centers. Providence hospitals and clinics are located in numerous areas, ranging from the Columbia Gorge to the wine country to sunny southern Oregon to charming coastal communities to the urban setting of Portland. If you want a vibrant lifestyle while working with a team highly committed to the art of healing, choose from our many options in Oregon.
We offer a full comprehensive range of benefits - see our website for details
As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.
Providence Health & Services is a not-for-profit Catholic network of hospitals, care centers, health plans, physicians, clinics, home health care and services guided by a Mission of caring the Sisters of Providence began over 160 years ago. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
Job Category: Quality/Risk/Safety (Non-Clinical)
Req ID: 263986