Senior Quality Management Coordinator

Found in: Appcast US C2 - 2 weeks ago

Philadelphia, United States Jefferson Health Plans 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.


Qualifications:

  • 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.


Skills, We Value

  • 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.

  • Senior Quality Management Coordinator

    6 days ago

    Philadelphia, United States Jefferson Health Plans 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...

  • Senior Quality Management Coordinator

    1 week ago

    Philadelphia, United States Jefferson Health Plans 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...

  • Quality Coordinator

    6 days ago

    Philadelphia, United States Haven Behavioral Healthcare Full time

    Haven Behavioral Hospital of Philadelphia is seeking caring and compassionate people to join our team of devoted healthcare professionals.POSITION: Full Time Quality CoordinatorHaven Behavioral Hospital of Philadelphia provides inpatient psychiatric stabilization and treatment to adults and older adults experiencing acute symptoms of depression, anxiety,...

  • Quality Coordinator

    4 days ago

    Philadelphia, United States Haven Behavioral Healthcare Full time

    Job DescriptionJob Description Haven Behavioral Hospital of Philadelphia is seeking caring and compassionate people to join our team of devoted healthcare professionals.POSITION: Full Time Quality CoordinatorHaven Behavioral Hospital of Philadelphia provides inpatient psychiatric stabilization and treatment to adults and older adults experiencing acute...

  • Senior Product Management Associate

    Found in: beBee jobs US - 1 week ago

    Philadelphia, Pennsylvania, United States tapwage Full time

    The Wolters Kluwer Medical Education & Medical Practice (MEMP) team is looking for a Product Management Coordinator to provide support to MEMP product management staff and our products. The Senior Product Management Associate will work with a variety of roles beyond the team including our editorial, marketing, sales, customer support and enablement, market...

  • Pmc Operations Project Manager

    5 days ago

    Philadelphia, United States Pennrose Management Full time

    Overview: The PMC Operations Project Manager is responsible for strategic project management at the highest level; development and implementation of project plans including timelines, budgets, and resources to ensure operational efficiency and project success. The PMC Operations Project Manager will coordinate with customers, discussing project adjustments...

  • Senior Project Manager

    1 week ago

    Philadelphia, United States IntePros Consulting Full time

    IntePros is seeking a Senior Project Manager to join our industry-leading healthcare client in Philadelphia, PA! This role will maintain an advanced portfolio of complex projects that meet the emerging needs of the department. This individual will work with departmental leadership to develop project plans that align with the strategic goals of the...

  • Quality Assurance Coordinator

    4 days ago

    Philadelphia, United States Addison Group Full time

    Job DescriptionJob DescriptionRole: Quality Assurance Coordinator Location: Philadelphia, PA Neighborhood: Center City, PA Job Type: 37.5 hours/week, Hybrid (2-3 days in office), Contract Pay Rate: $20/hourInternal Job ID: An Addison Group client is looking for a Quality Assurance Coordinator to join their team! Job Responsibilities: Oversee the processes...

  • Quality Operations Manager

    7 days ago

    Philadelphia, United States PCI Pharma Services Full time

    Summary of Objective:This position is responsible for overseeing the direction, training, organization, alignment, monitoring, and cGMPcompliance to ensure we deliver a safe and quality product. This position will oversee both the QualityAuditor and Label Room teams. This is a supervisory position of approximately 7-10 direct reports across various...

  • Quality Operations Manager

    Found in: Appcast US C2 - 1 week ago

    Philadelphia, United States PCI Pharma Services Full time

    Summary of Objective:This position is responsible for overseeing the direction, training, organization, alignment, monitoring, and cGMPcompliance to ensure we deliver a safe and quality product. This position will oversee both the QualityAuditor and Label Room teams. This is a supervisory position of approximately 7-10 direct reports across various...

  • Quality Operations Manager

    Found in: Appcast Linkedin GBL C2 - 2 weeks ago

    Philadelphia, United States PCI Pharma Services Full time

    Summary of Objective:This position is responsible for overseeing the direction, training, organization, alignment, monitoring, and cGMPcompliance to ensure we deliver a safe and quality product. This position will oversee both the QualityAuditor and Label Room teams. This is a supervisory position of approximately 7-10 direct reports across various...

  • Quality Assurance Coordinator

    1 week ago

    Philadelphia, United States JFK Behavioral Health Center Full time

    Job DescriptionJob DescriptionPOSITION OVERVIEW: Responsible for quality review of charts and documents under the regulatory licensing standards in order to ensure program efficacy and compliance; alternate administrator for Electronic Health Record system.  Our QA Coordinator will:Select charts, uses census tracking form for monthly chart-compliance...

  • Senior Project Manager

    Found in: Appcast Linkedin GBL C2 - 2 weeks ago

    Philadelphia, United States b19 Consulting Full time

    b19 Consulting is working with an established power & renewables engineering consultancy to find a Senior Project Manager.The role of Senior Project Manager plays a pivotal role in ensuring the success of Power Delivery Projects by fostering collaboration between the Client and Project Team across all project aspects.With a primary emphasis on client...

  • Senior Project Manager

    1 week ago

    Philadelphia, United States HBK Engineering Full time

    HBK Engineering is seeking a Senior Project Manager. This position offers the opportunity to be part of a project team consisting of professional engineers, project engineers and designers who are involved in the design, modification, and analysis of new and existing utility systems. A senior engineering project manager is responsible for managing staff,...

  • Marketing Coordinator

    6 days ago

    Philadelphia, United States City Fitness Management, Inc. Full time

    City Fitness is currently seeking a well organized, highly motivated, marketing enthusiast to enhance production and streamline activities within our Marketing Department. We are looking for someone to provide high level administrative support, who w Marketing Coordinator, Marketing, Coordinator, Project Management, Instructor, Business Services

  • Quality Manager

    2 days ago

    Philadelphia, United States Chromalox Full time

    At Chromalox , part of Spirax Group, we build advanced thermal technologies for the worlds most challenging industrial heating applications. Headquartered in Pittsburgh, Pennsylvania, we do it better and have been doing it longer than anyone else.Chromalox started with an innovative solution 100 years ago when a self-taught engineer invented the first...

  • PMC Operations Project Manager

    Found in: Resume Library US A2 - 5 days ago

    Philadelphia, Pennsylvania, United States Pennrose Management Full time

    Overview: The PMC Operations Project Manager is responsible for strategic project management at the highest level; development and implementation of project plans including timelines, budgets, and resources to ensure operational efficiency and project success. The PMC Operations Project Manager will coordinate with customers, discussing project adjustments...

  • Senior Production Manager

    2 days ago

    Philadelphia, United States QUAD, a SolomonEdwards Company Full time

    Senior Production ManagerAn industry leading Philadelphia organization is seeking a hands on Senior Production Manager to join their team.The Senior Production Manager will oversee six direct reports and will be responsible for all aspects of production operations management, as well as facilities maintenance and safety and quality standards...

  • Senior Production Manager

    Found in: Appcast Linkedin GBL C2 - 2 weeks ago

    Philadelphia, United States QUAD, a SolomonEdwards Company Full time

    Senior Production ManagerAn industry leading Philadelphia organization is seeking a hands on Senior Production Manager to join their team.The Senior Production Manager will oversee six direct reports and will be responsible for all aspects of production operations management, as well as facilities maintenance and safety and quality standards...

  • Senior Software Product Manager

    1 week ago

    Philadelphia, United States CareerBuilder Full time

    This is a remote position. This role requires you to be located in the United States. About Curotec We have a really interesting team of people that span many different skill sets, cultures, and backgrounds. We are a melting pot of sorts. One of the things our team members enjoy the most about working at Curotec is their ability to learn new things every...