JOB PURPOSE:

Under the direction of the Manager of Quality Review, the Quality Review Specialist is responsible to review, triage, process, and/or investigate, as necessary, all service determination requests received. Will perform a quality review of all data submitted by the IDT teams and PACE Service Coordinators in Care Compass. The role will ensure that service determination requests (SDRs) are handled in a timely and efficient manner and in compliance with the relevant policies & procedures. The role will also perform a variety of duties involving entering, confirming, and updating patient service support documentation. This will include frequent communication with participants and collaboration with various teams within to effectively collect and process participant data.


JOB RESPONSIBILITIES:
+ Reviews daily tasks and assign SDR cases for coordination with IDT and timely resolution.
+ Provides all administrative-related information and routes accor...