Manager, Provider Quality Oversight
IEHP
full-time
Posted on:
Location Type: Remote
Location: California • United States
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Salary
💰 $118,602 - $157,144 per year
About the role
- Leading the daily operations of the Potential Quality Incident/Provider Preventable Condition and clinical reporting nurse teams.
- Ensure the complete review of Quality-of-Care cases, adherence to standard work, reporting accuracy, and compliance with IEHP policies, Local, State, and Federal laws, and regulations.
- The planning and implementation of any quality audit initiatives, programs, and processes identified by IEHP’s Quality System.
- Responsible for managing direct reports to ensure effective resource management and prioritization of work in support of meeting Quality and Organizational goals and priorities.
- Responsible for the development, management, implementation, and evaluation of all areas of responsibility including, but not limited to, Potential Quality Incidents (PQI)/Provider Preventable Conditions (PPC) processes, Quality Reviews, and clinical audits of IEHP Providers to ensure clinically appropriate billing.
- Provide oversight and management of the PQI and PPC processes and staff to comply with IEHP policies, Local, State, and Federal standards, and regulations.
- Collaborate with appropriate internal and external departments, team members, and entities to achieve organizational quality initiatives, as assigned.
- Responsible for the development, maintenance, implementation, and adherence to departmental policies and procedures, standard operating procedures, and job aides.
- Participate in Quality Management activities and projects to ensure interventions meet project goals.
- Lead, prepare, and coordinate appropriate Provider Quality Review department related internal meetings.
- Represent IEHP in external meeting related to key areas of responsibility as appropriate.
- Ensure the privacy and security of PHI (Protected Health Information) as outlined in IEHP’s policies and procedures relating to HIPAA compliance.
Requirements
- Five (5) or more years of any individual or combined healthcare experience in quality management, quality assurance, quality improvement, utilization management, case management, acute care, and/or ambulatory care setting
- Three (3) or more years of experience in a supervisory or leadership role in any healthcare setting
- Experience in an HMO or Managed Care setting is preferred
- Bachelor's degree in Nursing from an accredited institution required
- Master's degree in Nursing from an accredited institution preferred
- Possession of an active, unrestricted, and unencumbered Registered Nurse (RN) license issued by the California BRN required
- Certified Professional in Healthcare Quality (CPHQ) certification preferred
- Knowledge of clinical audits, including medical record reviews
- Intermediate knowledge of word, excel, and PowerPoint.
- Intermediate computer skills
- Excellent verbal and written communication skills
- Builds effective work relationships
Benefits
- CalPERS retirement 457(b) option with a contribution match
- Generous paid time off- vacation, holidays, sick
- State of the art fitness center on-site
- Medical Insurance with Dental and Vision
- Paid life insurance for employees with additional options
- Short-term, and long-term disability options
- Pet care insurance
- Flexible Spending Account – Health Care/Childcare
- Wellness programs that promote a healthy work-life balance
- Career advancement opportunities and professional development
- Competitive salary with annual merit increase
- Team bonus opportunities
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
quality managementquality assurancequality improvementutilization managementcase managementclinical auditsmedical record reviews
Soft Skills
leadershipcommunicationrelationship buildingresource managementprioritization
Certifications
Registered Nurse (RN) licenseCertified Professional in Healthcare Quality (CPHQ)