The Quality Assurance and Compliance team seeks to build a culture of continuous improvement within the organization through detailed reporting, strategic advising, and proactive leadership. The South Carolina Department of Health and Human Services runs an internal case review process to assess the quality of services provided to South Carolina Medicaid members. These reviews aim to evaluate the appropriateness and effectiveness of care. Objectives of the Quality Assurance and Compliance Team:
The Quality Assurance and Compliance team is committed to enhancing healthcare services and ensuring optimal outcomes through the following actions:
- Assessing and improving healthcare services to achieve the best possible outcomes.
- Monitoring and evaluating service delivery systems, provider networks, and internal processes to identify areas for improvement.
- Implementing action plans to address deficiencies and improve clinical operations and sharing findings with both internal and external stakeholders.
- Developing comprehensive reports that detail processes, metrics, and outcomes.
- Advising management on key findings and providing actionable recommendations for continuous improvement.
- Identify potential areas for improvement through education and/or training.
- Provider Training