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The Georgia Department of Behavioral Health and Developmental Disabilities, (DBHDD), is seeking qualified candidates for the position of Director of Quality Management in the Office of Accountability and Compliance.

Under broad supervision, provides energetic and visionary leadership in the planning, development and implementation of a system-wide quality management program for hospital operations within the Department of Behavioral Health and Developmental Disabilities (DBHDD). Provides leadership and consultation for all hospital-based quality management directors. Assures that all hospital related quality management issues are systematically and systemically addressed, including requirements found in the Centers for Medicare and Medicaid (CMS) Conditions of Participation for Hospitals, The Joint Commission (TJC) and in the Civil Rights of Institutionalized Persons Act (CRIPA) Settlement Agreement with the Federal Department of Justice. Supervises the quality management data manager assigned to hospital operations within the Department of Behavioral Health and Developmental Disabilities.This position is located in downtown Atlanta. A sprawling metropolis of over four million people today, metro Atlanta has the vibrancy of the worlds great urban centers combined with the Southern charm of small town centers such as Roswell and Decatur. Here youll find historic sites from the Civil War through the Civil Rights era, as well as world-class shopping, entertainment, and nightlife.

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

Advocate Health Care is currently seeking candidates for a Quality Improvement- QI position.

This position is responsible for enhancing patient care and satisfaction through quality activity, monitoring and to coordinate and execute the specific tasks required for efficient and effective operation of the quality improvement program in accordance with department, contractual and regulatory agency standards.Qualifications: Good organizational and interpersonal skills.Computer skills, basic keyboard knowledge. Willingness to be flexible with work scheduleKnowledge of managed care or utilization review or hospital quality. BSN or 2-4 equivalent years experience in managed care.1-2 years experience in utilization management/QI activity. 3-5 years of clinical experienceCurrent RN license issued by the state of IllinoisCurrent CPR certificationAdvocate Health Care, based in Oak Brook, Illinois, is the largest fully integrated health care delivery system in metropolitan Chicago and the state of Illinois, and is recognized as one of the top health care systems in the country. Advocate is the second largest private sector employer in metropolitan Chicago with more than 25,000 associates and has the largest trauma network in the state of Illinois.

Focused on the future.Ours & Yours.Weiss Memorial Hospital, located along Chicagos lakefront, is focused on the future of our organization as well as the future of your career! Join our growing organization and see the difference it will make in your career.Quality AnalystYou will support quality process improvement projects by performing data abstraction, analysis and entry, data base development and report generation. Your responsibilities will include accurate database entry, collection, abstraction, analysis, interpreting and reporting quality data for Weiss Memorial Hospital executive staff, medical staff and appropriate teams and committees.Requires a Bachelors degree and current RNs license for the state of IL. You must have three or more years experience in Cardiology. Experience in data abstraction and interpretation, data entry, data analysis, creation of spreadsheets and displaying statistical information on outcome measures preferred. Excellent organizational skills will be necessary, as well as the ability to prioritize projects based on need and deadlines. CPR and ACLS required.

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.

GENERAL SUMMARY: Under general supervision of the Director of Quality, is responsible for facilitating continuous improvement activities using the Lean methodology PRINCIPAL DUTIES AND RESPONSIBILITIES:Coach and support teams and individuals on properly identifying the 7 wastesTeach and train teams and individuals on the application of problem specific tools to support the Kaizen Activity Facilitate the deployment of capable and successful Kaizen teams for the purpose of elimination of waste As applicable coordinate the documentation of Kaizen/experiment using standard Lean tools Insure proper implementation and continued follow-up until Kaizen/experiment is hardwired Conduct regular observations of completed Kaizen/experiments to support and coach Provide input and recommendations for further continuous improvement activities to area managers Support the development and implementation of organizational wide Lean learning. Establish and grow relationships with those closest to the work KNOWLEDGE, EXPERIENCE, AND OTHER JOB REQUIREMENTS:The level of knowledge equivalent to that is normally acquired through completion of a Bachelors DegreeStrong leadership, coaching and teaching abilities Five years of related experience, including first hand experience leading and conducting Kaizen events preferably in a health care environmentCandidate must be able to demonstrate first hand knowledge and proper use of Lean as a business strategy Strong analytical, organizational and problem solving skillsExceptional communication (primarily verbal and listening) skills with ability to interact effectively with all levels throughout the organization. Knowledge of personal computer applications (Excel, word, etc.) WORKING CONDITIONS: Normal sedentary office environment. Work requires frequent mental/visual effort in reviewing documents The above statements are intended to describe the general nature and level of the work being performed by people assigned this job. They are not exhaustive lists of all duties, responsibilities, knowledge, skills, and abilities associated with the job.

Vibrant, growing organization with opportunities to suit your professional skills and a diverse work environment.

Who Cares? We Do!. . . for our patients, our communities, and each other Allina Hospitals & Clinics!Located in Minnesota and western Wisconsin, we are a not-for-profit system of hospitals, clinics and other health care services, united in caring for our patients with unparalleled talent, knowledge and technology; caring for our communities through collaborative efforts to promote stewardship, compassion and wellness; and caring for each other in an environment that puts patients first and helps passionate people excel. This is what makes Allina unique. Won´t you join us?Allina Commons is the Minneapolis-based headquarters of Allina Hospitals & Clinics, a not-for-profit health care organization serving patients and communities. Approximately 1,600 corporate and administrative service employees work at offices within Midtown Exchange, site of the historic Sears retail complex at Chicago Avenue and E. Lake Street. This community landmark, adjacent to the campus of Allina´s Abbott Northwestern Hospital, is the second largest building in Minnesota and includes offices, an internationally themed public market and residential units.Responsibilities:Assess inpatient and observation admission according to admission criteria for all different hospital disciplines (Mental Health, Substance Abuse, Acute Care, Rehab, Observation, etc.) Assess clinical data from medical records to assure appropriateness of patient´s admission. Ensure proper authorization requirements are met with each admission. Monitor continued stay, identify potential issues, and communicate the results and opportunities to nurses, physicians, finance, case managers, and payers. Provide consultation to medical and nursing staff, health information management, payers, patients, and patients on potential issues with reimbursement of hospitalization. Evaluate potential denials or payment issues and initiate communication with physician and / or clinician to assure proper documentation for selected admission status. Assure proper physician order is in the record for the correct patient status. If the order is incorrect, facilitate discussion with the appropriate physician. Refers case to a review physician when the treatment request does not meet necessarily per guidelines, when guidelines are not available, or per customer account instructions. Referrals must be made in a timely manner, allowing the review physician time to make appropriate contact with the attending provider.Qualifications:RN - BSN preferred. 3-5 years of acute care experience preferred. Understanding/ knowledge of Interqual and Milliman and Roberson Admission criteria, preferred. Knowledge of medicare, medicaid, and other third party payer admission requirement. Knowledge of managed care concepts including utilization management, prior authorizations, and denial and appeal process.Pay, Benefits & Work Schedule:***Temporary position*** 32 hours per week Day and Evening shifts Every other weekendWe have a place for you at Allina Hospitals & Clinics. If you are interested in becoming part of our award winning team of professionals, please apply online today at www.allina.com/jobs and reference job opening id 416930. Allina is proud to offer highly competitive salaries and comprehensive benefits that include a 401(k)/403(b), tuition reimbursement, day care reimbursement accounts, banking services and much, much more. Check online for other opportunities throughout Allina!

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!