Provider quality specialist (org wide) (home based with field travel)

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Under the supervision of the Provider Quality Supervisor, the Provider Quality Specialist (PQS) position assists in maintaining a network of appropriate high-quality service providers to meet members’ needs; monitors provider quality and contract compliance while engaging with providers to proactively enhance quality of services. The Provider Quality Specialist assists providers to improve the quality-of-service delivery through the remediation of member and provider related incidents and licensure review matters; builds positive working relationships with service providers, and other stakeholders to develop and maintain contracts and community resources necessary to meet the needs of the Lakeland Care Inc. (LCI) membership. The PQS also collaborates with the Provider Specialist and Quality Specialist to maintain a network of providers that deliver high quality services to LCI members.

Essential Competencies:

• Collaborate in developing quality standard definitions for providers and consistent processes to evaluate the quality of services rendered to members.
• Maintain a thorough understanding of regulations relating to licensure in residential and skilled nursing facilities, as well as member rights (DHS 83, 88, 89, 94 and 132) and serve as a resource to providers to improve the quality-of-service delivery.
• Review quality data monthly to identify trends of quality concerns per established thresholds and make recommendations for action plans with providers towards quality improvement.
• Make recommendations to contracted providers’ policies and procedures, collaborate with providers regarding Statements of Deficiency (SODs) from regulatory agencies, conduct on-site provider visits as required, actively engage in provider oversight process, and make best practice recommendations to assist in enhancing the provision of provider quality.
• Promote quality work of the providers and is a strong leader in identifying and facilitating provider quality oversight.
• Communicate effectively with LCI contracted providers as well as other LCI departments to support and enhance organizational practices.
• Respect other opinions and concerns and value diversity in thought and action.
• Provide education to contracted providers regarding the Family Care program and state statutes.
• Collaborate with providers in LCI incident review, related policy/procedure review, risk remediation and best practices.

Requirements

• Bachelor’s degree in a human service or business-related field, or equivalent combination of formal education and experience required.
• Minimum of 3 years of experience working with the population(s) served in the Family Care program and/or service provider industry.
• Strong knowledge of the service provider industry, including licensing requirements and regulations.
• Must demonstrate proficiency in Microsoft Office (Word, Excel, PowerPoint, Outlook).
• Must have exceptional verbal and written communication skills.
• Effective communication skills, strong organizational skills, and meticulous attention to detail.
• Strong critical thinking and analytic skills.
• Ability to develop strong working relationships and disseminate information appropriately.
• Current driver’s license, acceptable driving record and proof of adequate insurance required.

Lakeland Care is a 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), we provide long-term care services to eligible elders and individuals with physical and intellectual or developmental disabilities.

Our Mission

Empowering Individuals. Strengthening Communities. Inspiring Futures.

Our Vision

To create a world we all want to live in.

Our Core Values

Kindness. Inclusion. Trust.

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 practices in E-Verify.