LOCATION:ON-SITE IN MADISON, WIPOSITION CONTINGENT UPON AWARD OF CONTRACTSUMMARY
Responsible for planning, coordinating, and directing the Quality Assurance, complaints, and grievances programs for the Wisconsin NEMT contract to ensure compliance with contractual, regulatory, and organizational quality standards. Leads service quality monitoring, performance measurement, trend analysis, complaint and grievance investigations, corrective action initiatives, and continuous improvement efforts. Collaborates across departments to identify quality concerns, analyze operational performance, implement data-driven solutions, and ensure compliance with Department requirements while promoting service excellence and positive member outcomes.
ESSENTIAL FUNCTIONS
- Establish, implement, andmaintainquality assuranceobjectives, policies, procedures, and performance standards that align with Department requirements, contractual obligations, and organizational goals.
- Direct and oversee quality assurance activities across call center operations, provider network performance, service delivery, complaints, grievances, and member experience programs.
- Manage complaint andgrievanceintake, investigation, resolution, documentation, and reporting processes to ensure compliance with contractual requirements, regulatory standards, and established timelines.
- Review, analyze, and evaluate quality monitoring data, call assessments, trip performance metrics, complaint trends, member feedback, audits, and operational performance indicators toidentifyopportunities for improvement.
- Conduct root-cause analyses and trend identification using quality assurance findings, complaints, grievances, and operational data to develop effective corrective and preventive action strategies.
- Develop, implement, andmonitorcorrective action plans in collaboration with Operations, Provider Network, Compliance, Call Center, and other business units to improve service quality and operational performance.
- Apply statistical analysis and quality improvement methodologies to evaluate process effectiveness, measure performance outcomes, and support continuous improvement initiatives.
- Maintain working knowledge of Medicaid, NEMT, Department, regulatory, and industry quality standards and ensure organizational compliance with applicable requirements.
- Support Department audits, special reviews, investigations, and quality-related inquiries by preparing documentation, reports, findings, and corrective action responses.
- Prepare, analyze, and present quality performance reports, trend analyses, audit findings, and improvement recommendations to executive leadership, management teams, and Department representatives.
- Supervise Quality Assurance staff, including workload management, performance evaluations, coaching, training, professional development, and correctiveactionas necessary.
- Design, implement, and coordinate quality assurance training programs, process improvement initiatives, and performance reinforcement activities based onidentifiedrisks and quality trends.
- Investigate, address, and resolve quality-related concerns, service issues, and stakeholder complaints while ensuringappropriate documentationand follow-up.
- Collaborate with cross-functional teams to improve operational processes, strengthen quality outcomes, and support organizational performanceobjectives.
- Serve as an active participant in organizational quality management initiatives and continuous improvement efforts.
- Perform other duties as assigned.
QUALIFICATIONS REQUIRED
- Strongexpertisein quality assurance,complaintsmanagement, grievance resolution, and continuous improvement within a regulated service environment.
- Demonstrated ability to analyze operational, service, quality, and performance data toidentifytrends, risks, root causes, and opportunities for improvement.
- Experience developing, implementing, andmonitoringcorrective action plans across multiple operational and functional areas.
- Strong leadership and supervisory skills with experience managing projects, guiding teams, and fostering cross-functional collaboration to achieve quality and performanceobjectives.
- Excellent written and verbal communication skills, including the ability to prepare executive-level reports, present findings, and communicate effectively with Department representatives, leadership, and stakeholders.
- Strong organizational, analytical, and problem-solving skills with the ability to manage multiple priorities, meet deadlines, andmaintainaccuratedocumentation in a high-volume environment.
- Knowledge of office operations, business processes, procedures, and administrative technologies.
- Ability to read, interpret, and analyze operational, financial, and performance-related reports.
- Proficiencywith Microsoft Office Suite, data reporting tools, and business intelligence applications.
- Working knowledge of healthcare, Medicaid, NEMT, transportation services, or other regulated quality oversight environments preferred.
- Demonstrated attention to detail and commitment tomaintainingdocumentationaccuracy, compliance, and audit readiness.
- Ability to work independently, exercise sound judgment, and adapt to changing priorities and operational needs.
- Willingness and flexibility toworkvaried schedules as business needs require.
MINIMUM REQUIRED EDUCATION/TRAINING
5+ years QA/complaints/grievances leadership experience in healthcare or high-volume service operations.
3+ years of supervisory responsibility in an office environment.
Bachelor's Degree in Business Administration preferred.
