Quality Specialist - WI Based Work from Home - Lakeland Care : Job Details

Join our award winning team as we support members! Position Summary:Under the general direction of the Quality Risk Manager, this position assists in coordinating and overseeing Lakeland Care, Inc.'s (LCI) quality management and risk management responsibilities. The Quality Specialist provides local support to Care Management Supervisors and Interdisciplinary Team Staff on matters related to quality of care provided to members, risk mitigation, and adherence to policies, procedures, and best practice standards. The Quality Specialist also collaborates with the Provider Quality Specialist and Provider Specialist to maintain a network of providers that deliver high quality services. Quality management includes discovery, remediation, and improvement of quality in services and processes both internally and externally. Risk mitigation includes identification of risk factors and development of plans to mitigate risk as well as safety and risk policy implementation.Responsibilities & Competencies:Monitor the Incident Management System (IMS) to include receiving, responding, and tracking member related events reported by the Interdisciplinary Team staff. Investigate and address member quality of care issues to assure appropriate care and service delivery.Assist in the facilitation of the External Quality Review activities related to IMS, member risk, and member rightsParticipate in the DHS Immediate Reporting process as it relates to receiving reports, gathering information, timely determination, and providing support to Care Management in strategies to mitigate imminent risk for the membership.Provide technical assistance to LCI staff regarding topics related to member risk and member rights.Collaborate with Care Management staff in the proper remediation and preventative strategies to reduce member risk, provider related concerns, and effective care planning. Serve as a member of the LCI's Appeal and Grievance Committee and interface with local and/or state advocacy agencies as needed. Requirements Bachelor's degree in Social Work, Nursing, Special Education, Rehabilitation, other related human services field, or equivalent combination of education and experience (includes knowledge, skills, and abilities).Minimum of three (3) years of experience with at least one (1) years' experience in risk-related work experience.Must possess intermediate skills with Microsoft Office Suite, particularly Word, PowerPoint, Excel, and Outlook. Knowledge of the nature and appropriate services for the treatment and care of physical disabilities, disabilities due to advanced age, and intellectual/developmental disabilities.Knowledge of member rights and appeal and grievance systems.Able to build and motivate teams with demonstrated leadership and facilitation experience.Effective written and oral communication skills.Ability to professionally and objectively review and discuss member events.Able to prioritize, organize and carry out work assignments independently and efficiently.Current driver's license, acceptable driving record and proof of adequate insurance required.Knowledge of the Wisconsin Family Care Program and managed care principles.Knowledge of Chapters 51, 55, 880 procedures and requirements related to member rights.Familiarity with documentation and reporting in an EMR.Lakeland Care is a Top Workplace award winning Wisconsin-based non-profit organization that focuses on creating a world we all want to live in. With long-standing roots as a managed care organization (MCO), Lakeland Care provides long-term care services and supports to eligible frail elders and individuals with physical and intellectual or developmental disabilities to achieve their daily and lifelong goals through Wisconsin's Family Care program. We are an equal employment opportunity employer functioning under an Affirmative Action Plan. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, disability status, protected veteran status or any other characteristic protected by law. We are an organization that participates in E-Verify.