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Operations Specialist Quality Management

Date:  Apr 15, 2021
Brand:  EyeMed Vision Care
Location: 

Costa Mesa, CA, US, 92626

Requisition ID: 335064 
Position:Full-Time
Total Rewards: Benefits/Incentive Information

 

There’s more to EyeMed than meets the eye. EyeMed is the fastest growing managed vision benefits company in the country with consistent double-digit membership growth! Through our commitment to innovation, we’re reimagining the way employers and their employees think about vision care. We want them to see life to the fullest and experience more of what’s best, not more of the same.  And if what’s best hasn’t been done yet, it’s our exceptional and passionate employees driving this change. But, our passion for vision isn’t just about vision insurance benefits. Our employees are proud to support and participate in life-altering global and local missions through our partnership with OneSight, a leading not-for-profit organization with a 100% focus on eradicating the world’s vision crisis.

 

Your family says a lot about who you are. EyeMed is a key member of the Luxottica family of companies, global leaders in the design, manufacture and distribution of fashion, luxury and sports eyewear.  In North America, Luxottica is the home to global brands Ray-Ban, Oakley and many top fashion house brands.  Our leading retail brands include LensCrafters, Sunglass Hut, Pearle Vision, Target Optical and Sears Optical.

 

If you’re passionate about driving innovation and change and interested in a career in the optical and insurance industry, EyeMed wants to start the conversation and help provide you a growth-focused opportunity with America’s fastest growing vision benefits company.

GENERAL FUNCTION

The Quality Management Specialist coordinates reports, presentations and follow-up for various quality related committee meetings, participates in internal and external audits; and assists with implementation of Quality Work Plan initiatives to improve the experience of members and providers in their interaction with EyeMed and MESVision.

 

MAJOR DUTIES AND RESPONSIBILITIES

  • Coordinates progression of Quality Work Plan initiatives within the Quality Improvement Team and with cross-functional teams through documented communication.
  • Compiles quality management results and objectively makes recommendations for process improvement.
  • Assists with preparation of reports and presentations, as needed, for internal and external quality committees: Quality Management Committee, Quality Improvement Committee, Public Policy Committee and MES Board of Director meetings.
  • Updates internal weekly dashboard reports and KPI’s. Updates project task lists, calendars, logs, and systems to assure accuracy and timeliness.
  • Assists the Clinical Director with grievances and further investigation of identified quality of care and provider FWA (fraud, waste, and abuse) issues.
  • Assists the Medical Director and Clinical Director with the utilization management process as it relates to quality management.
  • Prepares provider and member surveys results for presentation to leadership and quality committees.
  • Works with the Data Analyst and Quality Improvement Manager/Director to implement, report, and present results of the virtual provider audit program and document, track, and monitor related corrective action plans.
  • Participates with internal and external audit teams related to audits of credentialing, appeals/grievances, utilization management, and quality improvement/management subjects.
  • Works collaboratively with team members on patient record review and other functions within the quality management and quality improvement area.
  • Takes initiative in all aspects of responsibilities, anticipates needs of department leadership, and proactively communicates the status of assigned tasks.

 

BASIC QUALIFICATIONS

  • Bachelor’s Degree or equivalent work experience
  • 2+ years’ experience in healthcare, vision benefit or claims processing
  • Strong oral and written communication skills
  • Ability to work well independently, under pressure and multi-task
  • Ability to successfully work on multiple projects simultaneously while managing time effectively
  • Demonstrated resourcefulness in research and claim resolutions
  • Proficient in Microsoft Office Products (Outlook, Word, Excel and PowerPoint)

 

PREFERRED QUALIFICATIONS

  • Bachelor’s Degree
  • Vision plan administration or eye care provider office experience
  • Working knowledge of AS400/IBM-i claims interface systems

Upon request and consistent with applicable laws, Luxottica will provide reasonable accommodations to individuals with disabilities who need assistance in the application and hiring process.  To request a reasonable accommodation, please call the Luxottica Ethics Compliance Hotline at 1-888-887-3348 or e-mail HRCompliance@luxotticaretail.com (be sure to provide your name and contact information for either option so that we may follow up in a timely manner). 

We are an Equal Opportunity Employer.  All qualified applicants will receive consideration for employment without regard to race, color, gender, national origin, social origin, social condition, being perceived as a victim of domestic violence, sexual aggression or stalking, religion, age, disability, sexual orientation, gender identity or expression, citizenship, ancestry, veteran or military status, marital status, pregnancy (including unlawful discrimination on the basis of a legally protected pregnancy or maternity leave), genetic information or any other characteristics protected by law.  Native Americans receive preference in accordance with Tribal Law.


Nearest Major Market: Orange County
Nearest Secondary Market: Los Angeles

Job Segment: Operations Manager, Manager, Medical, Business Process, Operations, Management, Healthcare

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