Job Posting: The Quality Management Coordinator will assist the Manager of Quality Management – Clinical in the development, implementation and coordination of the Quality Management Program across the Cedars-Sinai Medical Care Foundation. The QM Coordinator's responsibilities include: assisting the investigation and resolution of patient complaints and appeals in accordance to health plan, state and federal regulations, and accrediting bodies; assisting with site visits; assisting with the assurance of overall QM program compliance across the Foundation. ESSENTIAL JOB DUTIES:
Coordinate the quality management program to ensure continual compliance.
Supports appeals, complaints, and grievance process tracking and reporting.
Maintains a thorough understanding of medical staff bylaws, NCQA standards and health plan policies and procedures.
Documents and monitors quality improvement projects with focus on process improvement implementations
Coordinates and supports quality committees, including agenda preparation, documenting meeting minutes and logistics
Assists with the maintenance of the Quality Management and Credentialing files.
Assists with preparation for the annual health plan audits, surveys and other audits as they pertain to quality and credentialing
Performs medical office site visits according to the health plan and/or other regulatory/accreditation/compliance requirements
Tracking, trending and data collection.
Other functions as requested by the Department. Cedars-Sinai will consider for employment qualified applicants with criminal histories, in accordance with the Los Angeles Fair Chance Initiative for Hiring.
Qualification Requirements/Preferences: Education Certifications/Licensure Experience Physical Abilities QUALIFICATIONS: The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. EDUCATION AND TRAINING:
Bachelor's degree required or equivalent combination of education/experience will be considered.
At least two years prior experience in an ambulatory care/Medical Group or HMO setting with Managed Care exposure preferred.
Excellent data management skills including use of excel, access and business intelligence dashboards.
Must be able to interact effectively via telephone and in person with medical staff, clinical and administrative staff.
Must be able to show understanding, patience, and tact when dealing with physicians, staff, and the public.
Must possess excellent verbal and written communication skills and be detail oriented.
Must be able to react professionally under pressure, possess and use mature and independent judgment.
Must be able to travel and possess reliable transportation inclusive of a current, valid California Driver's License and automobile insurance (collision and casualty).
Providing healthcare for more than 100 years, Cedars-Sinai has evolved into one of the most dynamic and highly renowned medical centers in the world. Along with caring for patients, Cedars-Sinai is a hub for biomedical research and a training center for future physicians and other healthcare professionals. This attracts exceptional talent to Cedars-Sinai, including world-renowned physician-scien...tists who seek a place where they can both conduct research and see patients--the ideal formula for discovery and its translation into cures. Our patients benefit from access to doctors at the top of their fields, and our researchers have an ideal community in which to study the impact of healthcare challenges, and reflect that knowledge in their research. The greater Los Angeles area in which Cedars-Sinai resides possesses unparalleled cultural and ethnic diversity which offers outstanding opportunities for translational and clinical research and a dynamic environment for medical education.Although community based, Cedars-Sinai is a major teaching hospital affiliated with the David Geffen School of Medicine at the University of California, Los Angeles (UCLA). Cedars-Sinai has highly competitive graduate medical education programs in more than 50 specialty and subspecialty areas, a graduate program in biomedical sciences and translational medicine, a clinical scholars program directed towards junior physicians with aspirations to become clinical scientists, and post graduate training opportunities.There are more than 250 full-time faculty members at Cedars-Sinai. The voluntary medical staff, comprised of more than 2,200 specialty board-certified or board-qualified physicians, represent all of the specialties and subspecialties and collaborate with full-time medical staff in the teaching responsibilities of the graduate medical education programs.