L&I’s Health Services Analysis (HSA) program within the Insurance Services Division is seeking a manager to direct a unit of 15 professional staff.  The Provider Quality and Compliance Manager establishes policies and processes to ensure effective implementation and management of quality of care reviews, the credentialing committee, delegated group oversight, medical billing/documentation audits, as well as the Independent Medical Examination (IME) and interpretation services programs. The manager provides oversight and instruction/coaching to assigned staff and establishes priorities to produce results that are accurate, thorough, and within established timelines. 

This position also manages multiple contracts, including several physician peer review contracts and two interagency agreements, and has oversight of all contracts within the unit.  This position also influences L&I’s relationship with external stakeholders, including healthcare providers and groups, business, and labor effectively communicating the department’s vision by ensuring effective collaboration with stakeholders. 

 What we are looking for:

• Analytical skills including critical thinking, data analysis, and research.
• Innovative thinking.
• Effective oral and written communication.
• Excellent organizational and time-management skills, able to develop and effectively prioritize multiple projects.  
• Proven leadership qualities.
• Demonstrated expert-level professional judgment in applying audit practices.
• Demonstrated experience in healthcare management.

Some of what you will do: 

• Supervise, mentor, and coach professional staff.
• Prioritize and support staff assignments.
• Ensure staff access to resources and technology to complete their work.
• Make presentations to internal and external audiences.
• Represent the unit in discussions with other HSA managers as well as with other division managers and executives.
• Participate on project teams as a Subject Matter Expert.
• Negotiate settlements on medical bill audits.
• Manage and communicate credentialing decisions made by the IME Review Team and by the Medical Director.
• Manage physician peer review contracts and interagency agreements.
• Facilitate the Independent Medical Examination (IME) Business and Labor Advisory Team and Roundtable meetings.
• Make recommendations for changes to WACs regarding independent medical examinations, interpretation services contract, and quality oversight processes.
• Conduct legislative bill analysis.

Qualifications

 Required:

• Bachelor’s degree in public administration, business, public health, or related field.
• Five (5) years of management experience in a health related field, including supervisory experience. Additional years of experience (beyond 5) may be considered in lieu of a degree.
• Demonstrated experience in change management and performance management.

 Preferred/Desired:

 Master’s degree in public administration, business, public health, or related field

• Three (3) years’ experience in contract management.
• One year experience in provider credentialing.
• One year experience in workers’ compensation.
• Three (3) years’ experience in leading or managing a major program.
• Certification in the following:
• NAMSS – Certified Professional Medical Services Management (CPMSM)
• NAMSS – Certified Provider Credentialing Specialist (CPCS)