07/06/2026
Responsible for the completion of assignments for the coordination of the Quality Management Program through problem identification, development and coordination of QM studies, investigation of quality-related member and practitioner inquiries, and plan compliance with state and federal regulations and accrediting bodies. Measures and analyzes results of QI activities, recommends interventions, and conducts follow-up.
Collaborates with Care Management, Customer Services, Provider Affairs, and other departments to provide rapid and thorough identification, investigation and resolution of member, practitioner, and provider quality related issues.
Works with plan Medical Director on development and revision of Clinical Practice Guidelines. Assists management with the revision of Quality Management policies.
Develops, maintains, and enhances reporting methods to identify trends in physician and member behavior. Completes applicable...
AF Group
Detroit, MI
Full Time
