Your search returned 6 jobs

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

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 Chicago´s lakefront, is focused on the future of our organization as well as the future of your career!

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.

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!

Kaiser Permanente is looking for a Mgr Utilization Mgmt

Qualifications: Current California RN license. BSN or BA or BS degree in healthcare related field such as management, health services administration. At least three (3) to five (5) years experience in utilization management and discharge planning in an acute care setting to also include previous supervisory or management experience. Demonstrated knowledge of operations and healthcare management; JCAHO, Title XXII, Medicare, MediCal and other local, state and federal regulations. Knowledge of managed care operations. Demonstrated interpersonal, negotiation, and management skills. Good oral and written communication skills.Duties: Assists in developing and maintaining policies and procedures for the Service Area or Medical Center related to Utilization Management. Collaborates with the multi disciplinary team´s to plan and coordinate care across the continuum. Coordinates and manages members´ care with non KFH hospital facilities and providers. Identifies risk management and quality of care issues across the continuum. Surfaces issues and any suggestions to the appropriate multi disciplinary team members. Manages transportation program to ensure appropriate utilization of resources which meet Health Plan guidelines and patient needs. Assures compliance with Federal, State, JCAHO, NCQA, other regulatory agencies and internal standards and requirements.Provides direction to staff regarding utilization review, care coordination, discharge planning, and other services across the continuum of care. Assists in conducting statistical studies in utilization trends, patterns, and outcomes. Hires, trains coaches, disciplines professional and clerical support staff. Consistently supports compliance and the Principles of Responsibility (Kaiser Permanente´s Code of Conduct) by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non compliance, and adhering to applicable federal, state and local laws and regulations, accreditation and licenser requirements (if applicable), and Kaiser Permanente´s 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.Kaiser Permanente is an EEO/AA Employer.Notes: Schedule varies.

Department: Quality Resources Management Schedule: Full-time (Year Around) Shift: Days Hours: 8am-5pm Job Details: - RN - BSN Preferred This position is responsible to review and assess VVMCs operations to abstract and develop data to assess VVMCs compliance with accreditation and other regulatory standards as well as to identify priority areas for quality improvement. This position will also support the investigation and follow-up on root cause analyses and other performance improvement activities.