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)
The Quality Improvement Liaison will apply his/her experience, skills and techniques to project activities to improve on the overall quality metrics within the organization. The position includes compliance and quality improvement projects (HEDIS/Medicare STARs, Medicare Risk Adjustment and Encounter data) related to all Preferred IPA product lines. The dynamic incumbent will interface with various internal and external entities or other health care stakeholders (health plans and other providers) to complete Quality Improvement projects as assigned (e.g., Health Plan Audits and various provider compliant requirements to enhance/re-enforce the core Quality Improvement metrics).
· High School Diploma required. Preferred candidates with an Associate Degree or higher.
· Minimum 3 year working experience in Health Care Quality/Quality Improvement in the health care or manage care industry.
· Experience with HEDIS/Medicare STARs, Risk Adjustment and Encounter data collection strategies.
· Experience using Microsoft Office tools including Outlook, Word, Excel, PowerPoint and Adobe Acrobat Professional.
· Experience with collecting medical records with the provider offices to impact HEDIS/Medicare STARs, Risk Adjustment and Ad Hoc requests to comply with Health Plan audits.
· Identify and collect medical records from providers for various Compliance/Quality Improvement projects.
· Collaborate with risk adjustment team to enhance RAF score/rates.
· Maintain good working relationship with provider offices/physicians.
· Develop and support strategic projects with upper management.
· Maintain a high level understanding of the business of the IPA/Medical Group.
· As needed, act as the project's point of contact for client questions on strategy and requirements, documentation, functionality and deliverables.
· Tabulation of Medical Records received: Organize and use standardized naming convention for medical records received from provider offices. Complete scanning of medical records if received by postal mail.
· Have a solid understanding of the project scope and any tasks/items impacting deadlines.
· Assist management with scheduling appointments with provider office staff to conduct chart reviews/audits/abstractions and trainings.
· As needed, work with Quality Improvement Supervisor to schedule and track the work of other team members.
· Adhere to company policies and procedures.
· Local travel up to 25% dependent upon business and client needs.
· Have valid driver license.
· Other projects as assigned.
· Demonstrate good verbal and written communication skills.
· Establish and maintain client relationships in a professional manner.
· Be comfortable interacting with internal and external entities.
· Act as an individual contributor, team lead, or team member for all assigned projects.
· Maintain an understanding of the direction and strategic initiatives in the healthcare insurance industry and how they may impact our mission.
No certification or professional licenses required for this job.
Job Type: Full-time
Pay: $52,000.00 - $58,000.00 per year
Benefits:
Schedule:
Ability to Relocate:
Work Location: Hybrid remote in Glendale, CA 91202
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