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Compliance Leadership Position - Not for Profit Organization

University of Washington Physicians (UWP) in Seattle, Washington is an academic faculty practice group of more than 1,500 physicians and health-care providers who practice at several major medical centers in the greater Seattle area and community-based practice sites around the state of Washington. Our clinicians are among the best and most sought-after in the world providing care for over a million patient visits each year in our outpatient primary-care clinics, specialty clinics, and emergency departments.UW Physicians has a current vacancy in its Compliance Officer position. This leadership position is responsible for developing and overseeing implementation of the compliance program for UW Physicians. Reporting to the Executive Director of UWP, this position also has a reporting relationship to the Associate Vice President for Medical Affairs/Chief Compliance Officer (AVP/CCO) for UW Medicine.The Compliance Officer plays an essential role as the primary content expert for clinical billing and documentation. He/she advises the Board of Trustees, the Business Excellence Committee, the President, Executive Director, Department Chairs and Clinical Directors, and Faculty on compliance risk assessment and mitigation strategies and establishes the audit, monitoring, and education programs. The Compliance Officer works cooperatively with compliance officers within the UW Medicine System and Children´s University Medical Group (CUMG) to ensure system-wide consistency in compliance practices and to identify and resolve shared issues and concerns.Qualifications for the Compliance Officer include the following: Bachelor´s degree in Business Administration, health information, or related field required. Master´s degree preferred; Five years experience in health care compliance required; Five years management experience required; Two years experience in academic health care environment required; In-depth knowledge of federal and state regulations as they pertain to physicians and other health care providers; Knowledge of physician billing, coding (CPT and ICD-9), and documentation required. Coding certification preferred; Ability to communicate effectively, both verbally and in writing, with employees, medical staff, board members, and external parties. Strong presentation skills; Ability to deal effectively with difficult situations; Ability to analyze information and evaluate results to choose the best solution and solve problems; Knowledge of business and management principles involved in strategic planning, resource allocation, human resources management and leadership, production methods, and coordination of people and resources; Proficiency with Windows based software and Microsoft Office Suite products.UW PhysiciansEqual Opportunity Employer

You can achieve more at HCA West Florida. With 16 hospitals located throughout Tampa, St. Petersburg, Sarasota and the greater Orlando area, you´re sure to find the one workplace that does more for you - personally and professionally. Our team is made up of 15,000 individuals united by one purpose: to make the most of each other´s talents. That means you´ll have the support and the resources you need to pursue your goals. Join us here for a rewarding future that focuses on what matters most to you.Northside Hospital & Tampa Bay Heart Institute, part of the growing HCA West and Central Florida hospital system, is known for a dedicated Cardiovascular and Neuroscience focus. Our 288-bed facility also has a reputation for achieving high levels of quality care within comfortable, high-tech setting. Respected Centers of Excellence include: Chest Pain Center * Heart & Vascular Institute * Spine Care Center * Stroke Center Join us now in the heart of St. Petersburg, Florida, where you´ll enjoy a short commute, easy beach access and more.Responsibilities:-Oversees the collection, compilation, analysis and presentation of core measure data-Supports and promotes the mission of the hospital and the Quality Department-Understands all general elements of the core measures database-Ensures reliability and validity of the core measures data-Facilitates timely submission of core measures data-Maintains working knowledge relative to Conditions of Participation, JCAHO standards and assists Director to perform facility tracers to ensure ongoing compliance, document and evaluate performance improvement requirements for JCAHO and CMS-Participates effectively in performance improvement initiatives such as FMECA, RCA, and Sentinel event and related action planning-Reports all opportunities to improve processes, policy/procedures-Prepares and presents requested reports regarding the findings and outcomes of the Core Measures-Collaborates with physician leadership for presentation of outcome data at department meetings for the purpose of quality improvement-Works collaboratively with Medical Staff coordinator to ensure ongoing medical staff peer review process through chart reviews and physician profiling activities within the defined facility structure-Works collaboratively through daily rounds with enterprise wide departments to support ongoing compliance with Federal, State and regulatory statutes and standards and medical staff and hospital staff education Skills Requirements Qualifications:-Minimum of 3-5 years hospital experience, with strong clinical background-Licensure as RN required-Quality Management experience is preferred.-Proven ability to work effectively with hospital and medical staff-Understanding of research principles and the scientific method-Skilled in medical record review and interpretation of care standards-Flexibility in scheduling-Highly motivated and organized with the ability to focus on project development-The employee will be proficient in performing the functions of this job after six months of orientation

Nemours is currently seeking a Performance Improvement and Patient Safety Coordinator for Joint Commission Accreditation and Environmental Safety located at our Alfred I. duPont Hospital for Children in Wilmington, DE.

This position is responsible for the coordination of the Joint Commission accreditation preparedness activities throughout the Delaware Valley and for ensuring the continuous readiness for announced and unannounced surveys of the hospital and affiliated organizations including offsite facilities. Responsibilities include meeting and demonstrating compliance to regulatory/accreditation requirements. This role will also coordinate development and implementation of programs designed to ensure employee, patient, and visitor safety and agency compliance with Environmental safety, health and environmental regulations for specified facilities and operations.Key Responsibilities:*Assists in the identification of specific organizational needs and priorities related to accreditation and safety *Collaborates with key stakeholders to develop long-range goals, objectives, and strategies for accreditation survey readiness and environmental safety *Establishes a process, in collaboration with Departmental Leaders, for proactively assessing the Hospital and/or Practice for Joint Commission accreditation survey readiness.*Establishes a process, in collaboration with Departmental Leaders, for proactively assessing the Hospital and/or Practice for Environmental safety, including Life Safety, improvement opportunities.*Utilizes appropriate assessment tools and techniques to assess compliance with Joint Commission Accreditation and Environmental Safety Standards*Analyzes data to identify trends and opportunities for improvement as assigned. Educates and acts as a resource to all hospital and practice personnel on standards related to Joint Commission accreditation and Environmental safety.*Be experienced in both successful accreditation preparation as well as environmental safety management. *Be able to relate to all levels within the organization in order to both assess their knowledge and compliance with the regulations as well as educate them when deficits are identified. *Be able to methodically assess the level of compliance with various accreditation and safety standards and then analyze the gaps in order to formulate an effective plan of correction.JOB REQUIREMENTS: *Successful candidate must be a RN or Certified Professional in Healthcare Quality (CPHQ). Must have Bachelor´s degree in health related field (Master’s preferred). Minimum of five (5) years experience in healthcare management and organization -wide accreditation activities. Minimum three (3) years experience with organization-wide environmental safety activities.At Nemours, we´re dedicated to achieving higher standards in children´s health. And we begin by caring for children as if they were our own. For more than 70 years, this has been the Nemours Way. Thank you for your interest.

DEPARTMENT:Skilled NursingSCHEDULE:Part-Time regular, 20 hours per week, Vary shift, Monday, Friday - 8:30am - 5:00pm &Wednesday - 8:00am - 12:30pm w / weekend rotation.EDUCATION/LICENSE/CERTIFICATION:BSN or BA in health care related field preferred. Graduate of accredited school of nursing. Current California RN license. PHN preferred. JOB SUMMARY:Conducts utilization review for in-house patients and those members at contracted facilities. Assists in the discharge planning process.QUALIFICATIONS:Previous experience in an inpatient setting (usually 2 years). Previous experience utilization experience required (usually 1 year). Clinical expert in area of review preferred. Demonstrated knowledge of diagnostic codes.PREFERRED QUALIFICATIONS:Previous experience in an inpatient setting (usually 2 years). Previous experience utilization experience required (usually 1 year). Clinical expert in area of review preferred. Demonstrated knowledge of diagnostic codes. Provide clinical oversight for determination of medical necessity for admission to SNF & clinical denials based on medical necessity. Cross train to provide coverage for dept. manager. Cross train for SNF case manager which responsibilities include daily case management of patients while they are in the SNF, working with Kaiser team and contracted SNF team to coordinate needed care, discharge plans, equipment, education, follow-up medical appointments and family interaction and participation in plan of care.Cross train to SNF placement desk working with hospital discharge planners to find an appropriate SNF, secure bed and coordinate patient transfer with discharge planner. This consists of screening referrals for skilled determination, collecting needed documents for placement, coordinate obtaining bed with the SNF vendors and discharge planners, reports on PD placements. Additional responsibilities: create bi-weekly work schedule, reconciliation of Avoidable Days, utilization management reports & appeals processSKILLS TESTING: DUTIES:Conducts utilization review for in-house patients as well as those members who have admitted to contracted facilities. Conducts clinical reviews based on established treatment criteria. Reviews utilization patterns, identifies trends and problems areas for special studies. Assists other healthcare providers in the discharge planning process and triaging on alternative unit of care. Assists in collecting and assimilating clinical data to enhance the quality of services. Generates quality improvement results. Collaborates with physicians on clinical reviews, keeps them appraised of Kaiser clinical criteria. Reports and investigates unusual occurrences and questions inappropriate decisions based on their professional expertise. Interviews patients/caregivers regarding care after hospitalization. Counsels on Medicare and health care plan coverage. Coordinates referrals to appropriate agencies/facilities. OTHER DUTIES:Conducts utilization review for in-house patients and those members at contracted facilities. Assists in the discharge planning process. Conducts utilization review for in-house patients as well as those members who have admitted to contracted facilities. Conducts clinical reviews based on established treatment criteria. Reviews utilization patterns, identifies trends and problems areas for special studies. Assists other health care providers in the discharge planning process and triaging on alternative unit of care. Assists in collecting and assimilating clinical data to enhance the quality of services. Generates quality improvement results. Collaborates with physicians on clinical reviews, keeps them appraised of Kaiser clinical criteria. Reports and investigates unusual occurrences and questions inappropriate decisions based on their professional expertise. Interviews patients/caregivers regarding care after hospitalization. Counsels on Medicare and healthcare plan coverage. Coordinates referrals to appropriate agencies/facilities. Must have experience in skilled nursing facility nursing as well as an understanding of Medicare guidelines for skilled nursing facilities and skilled coverage for care.Case management experience strongly recommended..Kaiser Permanente conducts compensation reviews of positions on a routine basis. At any time, Kaiser Permanente reserves the right to reevaluate and change job descriptions, or to change such positions from salaried to hourly pay status. Such changes are generally implemented only after notice is given to affected employees. Consistently supports compliance and the Principles of Responsibility (KP�s code of conduct) by maintaining confidentiality, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to applicable Federal and State laws and regulations, accreditation and licensure requirements, and KP policies and procedures. In addition to defined technical requirements, accountable for consistently demonstrating service behaviors and principles defined by the Kaiser Permanente Service Quality Credo, the KP Mission as well as specific departmental/organizational initiatives. Also accountable for consistently demonstrating the knowledge, skills, abilities, and behaviors necessary to provide superior and culturally sensitive service to each other, to our members, and to purchasers, contracted providers and vendors.PLEASE NOTE: - Kaiser Permanente is an AA/EEO employer

Johns Hopkins Bayview Medical Center

Open the door to the best of both worlds-Johns Hopkins Bayview Medical Center offers a unique environment that combines the prestige and opportunities of a respected academic medical center with the personality and camaraderie of a community hospital.We currently have an opening for a Quality Information Analyst.Responsibilities:- Navigating a number of electronic systems including Care Science, MHA Core Measures, Datamart, Meditech and other clinical information systems- Using statistical and analytical skills to maintain or enhance quality data information systems and resolving problems requiring a comprehensive and state-of-the art awareness of the technology- Communicating effectively in order to participate in hospital wide projects and individuals within the organization to identify and meet quality data needsRequirements:- Associates Degree, BSN preferred - Current Maryland licensure as Registered Nurse - Knowledge of theories, principles, and concepts typically acquired through completion of a degree in clinical informatics or at least 1 year of experience with clinical information systemsWe´ve listened to our nurses and understand the importance of providing excellent benefits that top what others in the industry can offer. We offer health, dental, and vision benefits, as well as tuition reimbursement for you and your dependents.

Specializing in you...serving San Diegos inland North County communities for more than 50 years, PPH is a family of outstanding healthcare facilities that cover an area of more than 800-square miles. As the largest hospital district in Southern California, we are also one of the most diverse. From our state-of-the-art Cardiac Care and Rehabilitation Facilities and busy Trauma Center to Home Healthcare, we deliver a full spectrum of health services to meet the needs of every member in our community.We have an excellent opportunity for a Full-Time Defense Audit Denials RN who will be responsible for the clinical review of all charges on patient encounters in five primary areas of focus: 1) payer defense audits 2) pre-billing chart to charge reviews on high risk patient encounters for compliance and /or lost revenue 3) post billing chart to charge reviews as areas of risk are identified 4) clinical denials to mitigate the loss of revenue 5) refund requests to review for missing chargesResponsibilities include:Summarize reviews into clear and concise reports for management review.Reports to include recommendations for corrective action, which can include staff training and process improvement; creates and maintains database of reviews performed and reports trends to management at least monthly; serves as a resource to clinical areas to identify lost charge improvement opportunities.Possess analytical ability to design methods, collect and review data, formulate appropriate solutions and compile reports. This individual prioritizes work based on findings and risk; performs multiple tasks and modifies review approaches based on the organizations changing situations and needs, and follows through to achieve final resolution. Ability to effectively communicate, both written and verbal, with all levels of the organization. Work independently and as a cohesive team member seeking opportunities throughout PPH to improve effectiveness in charge capture and increased accuracy of clinical documentation. Responsible for coordinating and managing appeals for clinical denial of payment by medical record review with input from the physician advisor, attending physician, nurse case managers, and UR nurses. Serves as a liaison between patient financial services (PFS). Provides Case Management (CM)and Utilization Review (UR) for appeal-denial related issues. Generates formal letters of appeal to the insurance carrier. Responsible for collecting and maintaining data relating to appeals and outcomes.Explores opportunities for improvement in an effort to increase hospital reimbursement and decrease the rate of clinical denials.Maintains ongoing education and working knowledge of insurance regulations and claims audit. Maintains data spreadsheets with ability to prepare and present reports as requested. Maintains and utilizes excellent interpersonal, verbal and written skills effectively with ability to work independently to prioritize workload to meet appeal deadlines. Performs other duties as assigned. Follows PPH rules, policies, procedures, applicable laws, and standards.Carries out the mission, vision, values, and quality commitment of PPH.We promote a philosophy that encourages growth and satisfaction. We provide a work environment that is open and empowering, where you can experience a wide range of clinical, educational, and management opportunities. We also support a healthy balance between your personal and professional lives. We are located in an area that is enriched with a sense of belonging, where everyone pulls together in a common philosophy of life. Its an area that affords all who live here the luxury to pursue any interest or lifestyle they choose.RequirementsMinimum Education: As required by certification and/or licensurePreferred Education: Bachelors Degree in NursingMinimum Experience: 2 years hospital denials management, 4 years experience in an acute care facility and/or health care consulting; and Quality Assurance/Utilization ReviewPreferred Experience: 4 years hospital denials management, 5 years experience in an acute care facility and/or health care consulting; Quality Assurance/Utilization ReviewRequired License: Current CA RN License and Valid Drivers LicenseWe invite you to join us in our Mission to Heal, Comfort, and Promote Health in the Communities We Serve!

Become a Cedars-Sinai Employee!

Hours: 8am - 4:30pm Days: Monday - FridayShift Type: DayWeekends: None Job Description: Cedars-Sinai Health System has an opening for a RN, Supervisor Case Review. The Case Review Supervisor will be responsible for the day to day oversight of the Peer Review Process. The supervisor will review correspondence and assist case review coordinators with routine process questions. The Supervisor must demonstrate initiative, resourcefulness and problem-solving skills in applying a detailed knowledge of the responsibilities, functions and underlying management structure of the department and of the larger Health System in organizing and prioritizing work, establishing procedures and systems and ensuring the orderly and timely flow of business. The Supervisor must possess a full understanding of the confidentiality requirements to effectively and legally communicate practitioner related issues. The supervisor will communicate to the Patient Safety Manager all concerns and issues of a non routine nature or potential safety issue. In addition, the supervisor will be responsible for coordinating the Ongoing Professional Practice Evaluation (OPPE) for the medical staff. The Supervisor will have oversight of the Case Review Coordinator who will focus on identifying professional practice trends that impact quality of care and patient safety. The Supervisor will utilize expert clinical knowledge and experience to collaborate with the Case Review Coordinator using the Medical Center and Department specific criteria. Education and Work Experience Preferences: Educational Requirements:Bachelors Degree preferred and course work in healthcare related field preferred.License/Certification/Registration Requirements:Current active licensure as Registered Nurse in California required; Certified Professional in Healthcare Quality preferred