Providence is calling a Quality Management Manager (RN) to our Providence Medical Institute Quality Management location in Torrance, CA.
In this position you will:
Work directly with the Medical Groups and Foundations and is responsible for integration and delivery of Quality Management MSO functions for the Medical Groups and Foundations, in compliance with delegated and regulatory requirements.
Lead the integration of MSO Quality Management programs, developing and implementing standard workflows across multiple delivery models, local markets, and diverse populations across the Southern CA market.
Responsible for performance in the areas of QM related issues, data management/submission, Appeals & Grievances, ICE Reporting, CAPs, Pay for Performance/CMS 5 Star, Patient Satisfaction Survey process and reporting, CAPG Standards of Excellence Survey preparation and submission.
Create a scalable organizational structure to support the medical groups through growth, including acquisitions of patient populations and provider groups.
Supervise the daily activities of the Quality Management Department Staff and the Appeals & Grievance Coordinators to assure accurate and timely response to health plans.
Direct the oversight of reporting, compliance, efficiency and accuracy of the QM process as delegated by each PSA with the health plans, including quality metrics management and reporting, event reporting, appeals and grievances, and patient safety in the ambulatory setting, in accordance with our Program Plan, policies and procedures.
Assist in developing and implementing a robust set of actionable quality reports and tools such as the MDX Registry and documentation of workflows to improve quality metrics and patient outcome.
Instrumental in developing and implementing tools to improve accountability and patient safety, such as High Reliability Organization (HRO).
Responsible for compliance with health plans/NCQA/DMHC health care quality mandates and for the preparation and submission of audits and required health plan reports.
Collaborate with Providence Health and Services (PHSCA) Medical Groups and Foundations leadership on all audits results and needed corrective action plans.
Effectively drives consistent high quality care delivery in a rapid growth environment and across multiple ambulatory care delivery systems (employed, contracted and IPA) and various risk levels.
Lead integration across the MSO in delivering QM functions cross multiple medical groups.
Drive rapid process improvement to increase organizational efficiency.
Effectively uses data to evaluate opportunities, support interventions and measure results.
Instrumental in the evaluation, selection process and implementation of technology solutions to support QM functions.
Lead organizational and cultural transformation, and inspires others to create highly effective teams.
Demonstrate effectiveness and ability to work in partnership across reporting and organizational structures, including hospitals, partners and medical groups in Southern CA and across the Providence St. Joseph Health organization.
Required qualifications for this position include:
Bachelor's degree in Nursing.
RN graduate of an accredited school of nursing with a current California RN license.
Minimum three to five years experience of clinical nursing in medical setting with strong emphasis on surgical nursing or specialty area.
Minimum two years of management experience.
Experience with HMOs and health plans highly recommended.
Experience in developing educational programs and procedures.
Knowledge of Title XXII, NCQA, AAAHC requirements and standards, CDC and infection control standards, building codes, fire department safety standards, OSHA requirements (Title VIII).
Must possess excellent teaching skills including presentation.
Preferred qualifications for this position include:
Providence Health & Services Southern California is further developing its physician integration strategy. Historically, the largest asset has been Providence Medical Institute, a medical foundation that provides administrative and other support services to affiliated medical groups. Providence Medical Institute is expected to grow significantly in the next several years, bringing with it facilities, staff and physician growth to support that objective.
We offer a full comprehensive range of benefits - see our website for details
As people of Providence, we reveal God's love for all, especially the poor and vulnerable, through our compassionate service.
Providence Health & Services is the third largest not-for-profit health system in the United States. Providence employs more than 82,000 caregivers (employees) across a five-state area; AK, WA, MT, OR, and CA. Our facilities include 34 hospitals, 600 physician clinics, senior services, supportive housing and other health and educational services. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.