Manager CQA-Virtual PTOT

American Specialty Health Incorporated (ASH) is seeking a Manager - Virtual PTOT to join our Clinical Quality Administration department.

The primary purpose of this position is to coordinate and support the Virtual Physical Therapy quality management processes within the Clinical Quality Administration (CQA) Department including committee support, staff training, accreditation support, and other assigned duties. Collaborates with VP Virtual Physical Therapy and Sr VP Clinical Quality Administration.

Remote Worker Guidelines

• Remote Worker Guidelines: This position will be trained remotely and must be able to work from home (WFH) in a designated work area with company-provided technology equipment. This WFH position requires you have a stable connection to your Internet Service Provider with the ability to participate by video in online meetings over a reliable and consistent network. The internet connection must have a consistent 50 down/10 up Mbps minimum internet speed. 100 down/20 up is recommended to support higher quality video meetings.

Responsibilities

• Assist in the management of Clinical Quality Administration functions within the organization as directed by management. Supports CQA and VPT leadership as directed. Assists in management and is accountable for all activities within assigned scope of authority. Ensures accuracy and productivity in project completion and works cooperatively with all internal and external contacts. Achieves and exceeds company standards in management of quality management tasks.
  • Support CQA leadership in all requested CQA functions and departmental goals.
  • Monitors clinical quality trends related to virtual PT/OT and reports findings to ASH senior leadership; makes program improvement recommendations to senior leadership of VPT and Health Services.
  • Supports ASH senior leadership with recommendations for program enhancements and quality improvement activities; assists in implementing updates and enhancements that are approved.
  • Manages virtual PT guidelines and policy content development and editing in collaboration with Health Services policy team and committees.
  • Collaborates with VPT leadership and staff in management and deployment of provider training materials updating, editing, and providing training to providers and staff regarding ASH VPT/OT services and policies.
  • Serves on ASH Clinical Peer review committees as assigned.
  • Supports Senior ASH leadership in development and expansion of the ASHCare virtual clinical products.
  • Assists with EMR enhancements.
  • Assists with outcomes measurement and reporting.
  • Support URAC telehealth accreditation activities including documentation and other related activities.
  • Participates, as assigned, in external telehealth events and organizational activities such as ATA, APTA, or other meetings to obtain market information and represent ASH.
  • Supports the documentation of ASHCare annual quality improvement program, plan, and evaluation.
  • Assists with data reporting for ASH Board reporting.
  • Collaborates with VPT/OT team members to obtain input about patient care needs and assists in escalations and acuity concerns.
  • Support clinical quality administration activities as requested (e.g. grievance review; appeals; practitioner Corrective Action Plans; Practitioner educational interventions).
  • Investigate issues, develop and review current Corrective Action Plans (CAP) and follow up CAP responses.
  • Support VPR related CSIT and HSIT and reporting processes.
  • Sit in on PRC &/or respond to Practice Review Committee (PRC) requests.
  • Create tracking devices to track all information to report for audits.
  • Support practitioner hearings.
  • Reporting of data for CPM reports (CSIT, HSIT, CAPs, terminations, etc.).
  • Support NCQA, URAC, and health plan requirements compliance and audits.
  • Be able to search data bases for claims, records, utilization, etc.
  • Assist with phone calls received from practitioners including but not limited to credentialing denials, appeals, practitioner education, practitioner terminations, etc.
  • Manages projects in support of department goals.
  • Support sales and marketing education and training programs related to Rehabilitation Services (Physical Therapy, Occupational Therapy, and Speech Therapy).
  • Support Practitioner Contracting Communications through practitioner education and outreach efforts as required by department leadership.
  • Serve as resource to directors, managers, and staff relating to compliance and/or procedural inquiries.
  • Manage the accuracy and confidentiality of quality-related communication and minutes.
  • Assist staff, as appropriate, in supporting the resolution of quality-of-care issues.
  • Attend meetings with customers when requested.
  • Support the development and writing of QIA's and QI studies and presentation to appropriate committees for review and recommendations.
  • Assist in development of annual QI evaluation, QI program, and QI work plan.
• Performs other duties as assigned.
• Complies with all policies and standards.

Qualifications

• Degree from an accredited professional educational institution in Rehabilitative Health Care fields required.
• Degree in Physical Therapy or Occupational Therapy preferred.
• 5 years in health care administration or clinical experience required. Specific experience to include development and leadership of virtual services program for physical therapy.
• Experience in delivering virtual physical therapy as lead clinician in vertically integrated physical therapy programs required.
• Experience with direct client engagement and support for virtual therapy services required.
• Experience with client sales and support to conferences, health fairs, and support to development of marketing materials required.
• Experience in Quality Improvement data analysis preferred.
• Demonstrated writing proficiency required.
• 1-3 years of supervisory experience preferred.
• Knowledge of Artificial Intelligence programs preferred.
• Knowledge of health care and/or legal terminology preferred.
• Strong understanding of ICD-10 and CPT coding.
• Knowledge of health care and/or legal terminology preferred.
• High level of attention to detail is required.
• Demonstrated process development, research, and English writing proficiency required.
• Ability to determine the medical necessity of services based on data provided and ASH guidelines.
• Use of computer systems in business application including, but not limited to, 10-key, Outlook, MS-Word, MS-Excel, IHIS, SharePoint, and Microsoft Teams.
• Valid license in the related Rehabilitative Health Care specialty (PT, OT) required. Must be in good standing with all judicial or governing bodies required.

Core Competencies

• Demonstrated ability to interact in a positive, respectful manner and establish and maintain cooperative working relationships.
• Ability to display excellent customer service to meet the needs and expectations of both internal and external customers.
• Excellent listening and interpersonal communication skills to identify critical core competencies based on success factors and organizational environment.
• Ability to effectively organize, prioritize, multi-task and manage time.
• Demonstrated accuracy and productivity in a changing environment with constant interruptions.
• Demonstrated ability to analyze information, problems, issues, situations, and procedures to develop effective solutions.
• Ability to exercise strict confidentiality in all matters.

Mobility

• Primarily sedentary, able to sit for long periods of time.

Physical Requirements

• Ability to see, speak, and hear other personnel and/or objects. Ability to communicate both in verbal and written form. Ability to travel within and around the facility or Work from Home (WFH) environment. Capable of using a telephone, computer keyboard, and mouse. Ability to lift up to 10 lbs.

Environmental Conditions

• Work-from-home (WFH) environment.

American Specialty Health is an Equal Opportunity/Affirmative Action Employer.

All qualified applicants will receive consideration for employment without regard to sex (including pregnancy, childbirth, related medical conditions, breastfeeding, and reproductive health decision-making), gender, gender identity, gender expression, race, color, religion (including religious dress and grooming practices), creed, national origin, citizenship, ancestry, physical or mental disability, legally-protected medical condition, marital status, age, sexual orientation, genetic information, military or veteran status, political affiliation, or any other basis protected by applicable local, federal or state law.

Please view Equal Employment Opportunity Posters provided by OFCCPhere.

If you are a qualified individual with a disability or a disabled veteran, you have the right to request an accommodation if you are unable or limited in your ability to use or access our career center as a result of your disability. To request an accommodation, contact our Human Resources Department at (800) 848-3555 x6702.

ASH will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the Company's legal duty to furnish information.

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