Top Quality Management Executive - Healthcare jobs in Erie, PA
Top Quality Management Executive - Healthcare oversees all aspects of the quality management function for a hospital or other healthcare facility. Develops plans designed to improve the overall quality of the organization's facilities and patient care services. Being a Top Quality Management Executive - Healthcare oversees the implementation of quality improvement efforts designed to improve clinical performance and maintain compliance with JCAHO, HIPAA, and other accreditation standards. Responsible for planning and directing quality policies, programs, and initiatives. Additionally, Top Quality Management Executive - Healthcare requires a MD from an accredited school. Requires a valid state license to practice. Typically requires extensive clinical experience. Typically reports to a top management. The Top Quality Management Executive - Healthcare manages a business unit, division, or corporate function with major organizational impact. Establishes overall direction and strategic initiatives for the given major function or line of business. Has acquired the business acumen and leadership experience to become a top function or division head. (Copyright 2024 Salary.com)
Recently Added Top Quality Management Executive - Healthcare jobs
Quality Management Coordinator II
- Health Partner Plans, Inc.
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Erie, PA
FULL_TIME
-
Jefferson Health Plans is committed to the development of its staff and the achievement of their career goals. We are hiring a Quality Management Coordinator II to join our team! We are committed to creating a community where everyone belongs, acknowledges, and celebrates diversity and has opportunities to grow to their fullest potential.
While this job currently provides a flexible remote option, due to in-office meetings, training as required, or other business needs, our employees are to be residents of PA or the nearby states of DE or NJ.
Working under minimal supervision perform and document quality monitoring, medical record review and focused study activities to measure plan performance with clinical, service, and administrative indicators established by the Quality Management Department, regulatory and accrediting bodies.
As the Quality Management Coordinator II, your daily duties may include:- Perform investigations of potential quality of care concerns referred to the QM Department from multiple internal resources and external sources such as but not limited to: UM, Care Management, Complaints and Grievances and Provider Tip Line.
- Perform quality of care reviews on cases identified as Preventable Serious Adverse Events, based on the CMS / DPW Bulletin.
- Procure medical records as indicated based on case review.
- Perform clinical reviews on medical records to verify QOC issues, PSAEs, or payment retractions.
- Work collaboratively with Claims and Operations and Medical Management to ensure the PSAE review process is seamless and meets with regulatory requirements.
- Perform medical record reviews and use clinical judgement to determine if issues are identified.
- Create summaries of medical record reviews and collaborate with Medical Director when indicated. Presents and participates in all applicable cases approved by Senior Medical Director to Credentialing Committee for peer review.
- Prepare identified cases for internal physician peer reviews and presents cases at credentialing meeting.
- Prepare cases for external peer review as needed.
- Maintain timeliness in all case reviews and investigations.
- Identify opportunities to work with providers to ensure a quality-of-care partnership and act as a liaison for quality and patient safety for par facilities and par providers.
- Utilize the Healthcare Management integrated software system to build and track cases referred for quality of care, member complaints and PSAE’s.
- Participate in annual required training and competency testing for inters rater reliability.
- Participate in evaluation process with QM Management Team to identify recommendations for process improvement.
- Contribute to the development and enhancement of documentation, tracking tools and process flows for quality monitoring and audit activities as assigned by the Management Team.
- Participate in practitioner medical record review process for HEDIS when indicated, PA Performance Monitoring and other regulatory or QM related activities. Participate in work groups as assigned.
- Attends inter-departmental meetings alongside QM manager and Director; updates processes and/or workflow activities to departments such as Utilization Management and Complaints and Grievances, and Credentialing Committee.
- Other duties as assigned.
- Graduate of accredited school of nursing, RN
- 2 years of experience in quality management monitoring activities and/or credentialing/ recredentialing reviews, development, implementation, and evaluation of quality management activities in acute and/or ambulatory health care settings.
- Managed care experience preferred. Knowledge of medical coding preferred.
- Excellent verbal and written communication skills.
- Ability to present and discuss clinical quality of care issues with QM Manager and Medical Director.
- Strong analytical and problem-solving skills.
- Strong organizational skills and ability to manage multiple priorities.
- Knowledge of NCQA standards preferred.
- Ability to function independently with minimal supervision.
- Basic understanding of QM principles.
- Basic computer skills in Outlook, MS Word, Excel and Access preferred.
- Just Posted
Executive Chef
- Forefront Healthcare & Culinary Services
-
Edinboro, PA
FULL_TIME
- Company DescriptionForefront Healthcare is unique, experienced, and specialized in serving the continuum of care. With finely tailored, high-quality culinary and support services, Forefront helps its ...
- 4 Days Ago
Executive Chef
- Forefront Healthcare & Culinary Services
-
Meadville, PA
FULL_TIME
- Company DescriptionForefront Healthcare is unique, experienced, and specialized in serving the continuum of care. With finely tailored, high-quality culinary and support services, Forefront helps its ...
- 4 Days Ago
Executive Chef
- Forefront Healthcare & Culinary Services
-
Erie, PA
FULL_TIME
- Company DescriptionForefront Healthcare is unique, experienced, and specialized in serving the continuum of care. With finely tailored, high-quality culinary and support services, Forefront helps its ...
- 4 Days Ago
Lead Quality Assurance Specialist
- US Defense Contract Management Agency
-
Meadville, PA
FULL_TIME
- Duties Serves as a team leader for a quality assurance team, assigning work, providing feedback, checking progress, arranging training for team members, and providing input to supervisor. Reviews cont...
- 8 Days Ago
Electro-Mechanical Technician
- Human Castle Executive Search
-
Erie, PA
FULL_TIME
- Due to exponential growth, Human Castle is assisting global manufacturing powerhouse in the Southtowns in the hiring of several ElectroMechanical Maintenance Technicians across several shifts. These a...
- 27 Days Ago
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0 Top Quality Management Executive - Healthcare jobs found in Erie, PA area
Licensed Practical Nurse, LPN (Night Shift)
- Interim HealthCare
-
Erie, PA
- As a Licensed Practical Nurse (LPN) you will be called to care when you’re needed most. As part of Interim Healthcare Ho...
- 4/23/2024 12:00:00 AM
Registered Nurse (Weekend Support) Full Time
- Interim HealthCare
-
Erie, PA
- Our RN Case Managers (RNCM/ Visiting Nurses) have been called to care when they’re needed most. As a member of our home ...
- 4/23/2024 12:00:00 AM
Executive Chef
- The Kahkwa Club
-
Erie, PA
- A private and prestigious Club in Erie, Pennsylvania established in 1893 is looking for a new Executive Chef. The Kahkwa...
- 4/23/2024 12:00:00 AM
Account Executive
- Centric Business Systems - powered by UBEO
-
Erie, PA
- UBEO Business Services, the premier provider of business technology products and services, is seeking to hire a Sales Re...
- 4/23/2024 12:00:00 AM
Travel Cardiac Sonographer - $2,162 per week
- Hiring Now!
-
Erie, PA
- ARMStaffing is seeking a travel Cardiac Sonographer for a travel job in Erie, Pennsylvania. Job Description & Requiremen...
- 4/23/2024 12:00:00 AM
Travel Echo Technologist - $2,108 per week
- Stability Healthcare
-
Erie, PA
- Trustaff Allied is seeking a travel Echo Technologist for a travel job in Erie, Pennsylvania. Job Description & Requirem...
- 4/23/2024 12:00:00 AM
Travel Nurse RN - ICU - Intensive Care Unit - $2,344 per week
- Hiring Now!
-
Erie, PA
- Trustaff is seeking a travel nurse RN ICU - Intensive Care Unit for a travel nursing job in Erie, Pennsylvania. Job Desc...
- 4/23/2024 12:00:00 AM
Caregiver Hiring Event
- Help At Home
-
Erie, PA
- Job Description Job Description Help at Home is hosting an Onsite Hiring Event for Caregivers at our Erie, PA. location–...
- 4/23/2024 12:00:00 AM
About Erie, Pennsylvania
Erie (/ˈɪəri/; EER-ee) is a city on the south shore of Lake Erie and the county seat of Erie County, Pennsylvania, United States. Named for the lake and the Native American Erie people who lived in the area until the mid-17th century, Erie is the fourth-largest city in Pennsylvania, as well as the largest city in Northwestern Pennsylvania, with a population of 101,786 at the 2010 census. The estimated population in 2017 had decreased to 97,369. The Erie metropolitan area, equivalent to all of Erie County, consists of 276,207 residents. The Erie-Meadville, PA Combined Statistical Area has a pop...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Top Quality Management Executive - Healthcare jobs
$370,518 to $536,293
Erie, Pennsylvania area prices
were up 1.5% from a year ago
were up 1.5% from a year ago
What does a Top Quality Management Executive - Healthcare do?
Top Quality Management Executive - Healthcare in Petaluma, CA
“By becoming an ACHE Fellow and earning the distinction of board certification, healthcare leaders demonstrate a commitment to excellence in serving their patients.”.
December 03, 2019
Top Quality Management Executive - Healthcare in Florence, AL
“The healthcare management field plays a vital role in providing high-quality care to the people in our communities, which makes having a standard of excellence promoted by a professional organization critically important,” says Deborah.
December 16, 2019