Overview
Manager-Utilization Management Contract Quality and Oversight Jobs in Albuquerque, NM at Presbyterian Healthcare Services
Job description
Company Overview
Essential HealthCare Solutions (EHS) is dedicated to addressing complex healthcare challenges through innovative solutions. With a strong leadership team and a focus on quality service delivery, we provide comprehensive healthcare support across various verticals, including medical staffing, compliance, provider network development, and behavioral health program development.
Summary
As a member of the Essential HealthCare Solutions team, you will be instrumental in delivering high-quality healthcare services. This role is essential in ensuring patient care excellence and supporting our mission to create safer and healthier communities. We are seeking a goal-oriented problem solver and team player who is ready for the responsibility required to work in a professionally exciting environment. This role ensures quality of care for patients and residents in healthcare facilities nationwide while sharing knowledge and expertise to support the company’s mission of providing superior customer service.
Responsibilities
This position is 100% remote with up to 75% travel. The Quality Assurance/Compliance Medical Facility Surveyor will serve as a team member or leader on various types of surveys, including:
Long-Term Care (LTC) and Non-Long-Term Care Surveys (re-certification, comparative, complaint investigation, and revisits).
The surveyor will travel nationwide to healthcare facilities, assessing compliance with federal and state regulations governing the quality of care for residents. The role requires applying approved survey protocols during evaluations. Specific duties include:
Conducting surveys of Medicare-Medicaid certified healthcare facilities to ensure compliance with federal regulations.
Preparing for surveys through off-site preparation, touring the facility, observing care, reviewing records, and interviewing staff and residents.
Evaluating quality of care, consumer rights, clinical documentation, physical plant requirements, and overall facility operations.
Communicating non-compliance findings to key facility personnel throughout the survey process, including during the exit conference.
Determining if corrective action plans are acceptable and ensuring implementation.
Conducting follow-up visits and monitoring surveys to verify compliance.
Assisting with facility and bureau training as needed.
Participating in workgroups for ongoing process improvements.
Qualifications:
Associate or Bachelors degree in a clinical or related discipline.
Completion of CMS Long-Term Care Basic Training and successful completion of the Surveyor Minimum Qualifications Test (SMQT) preferred.
At least two (2) years of experience as a surveyor accrediting or certifying facilities serving long-term care residents.
Experience in Quality Measures (QM) derived from the Resident Assessment Instrument (RAI) / Minimum Data Set (MDS).
Active clinical licensure (e.g., RD, LCSW) is highly desirable.
Federal survey protocols, including the ability to assess Nursing Homes, Domiciliary, and Adult Day Health Care Programs.
Ability to review, score, and document compliance using survey forms, including Nursing Home Survey Reports, Domiciliary Survey Reports, and Adult Day Health Care Survey Reports.
Ability to set priorities independently and work effectively within a team setting.
Strong conflict-resolution skills and the ability to escalate concerns appropriately.
Willingness to travel up to 75% of the time on a regular basis.
Experience Required:
Previous CMS or state survey experience conducting nursing home inspections.
Knowledge of long-term care facility operations and regulations.
Experience with Medicare-Medicaid compliance reviews.
Facilities covered: Nursing homes, ambulatory surgical centers (ASC), Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICFs/IID), end-stage renal disease (ESRD) centers, Psychiatric Residential Treatment Facilities (PRTF), hospitals, critical access hospitals, and hospice facilities.
Job Type: Full-time
Pay: $40.00 – $50.00 per hour
Expected hours: 40 per week
Benefits:
Dental insurance
Employee assistance program
Health insurance
Paid time off
Retirement plan
Vision insurance
Schedule:
Day shift
Monday to Friday
Experience:
medical facility survey: 2 years (Required)
surveyor for healthcare facilities: 2 years (Required)
Willingness to travel:
75% (Required)
Work Location: Remote
Title: Manager-Utilization Management Contract Quality and Oversight
Company: Presbyterian Healthcare Services
Location: Albuquerque, NM
