Dignity Health Management Services

Where You’ll Work The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric, full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health’s Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups, hospitals, health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first. Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art, flexible Health & Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options, including medical, dental and vision plans, for the employee and their dependents, Health Spending Account (HSA), Life Insurance and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave. One Community. One Mission. One California Job Summary and Responsibilities As the Manager, Quality, you will be responsible for the implementation and management of the Performance Improvement (PI) plan and maintaining compliance with Joint Commission and relevant State and Federal regulations related to quality monitoring and performance improvement. The Manager will also oversee the day-to-day operations of the Quality Management staff. Success in this role requires a deep understanding of healthcare quality and risk management, strong analytical and leadership skills, an unwavering commitment to patient safety, and the ability to implement robust programs. - Assists in the design, planning, implementation and coordination of Quality Management, Patient Safety and Performance Improvement activities for the assigned hospital(s) and medical staff departments, committees, divisions, service lines and functions. Proactively coordinates and facilitates performance improvement teams to support key initiatives, including but not limited to, activities focused on clinical quality improvement. Participates in an integral role to ensure compliance with CMS HIQRP/HOQRP, TJC, Leapfrog, etc., data collection and reporting of process and outcome measures.- Maintains current knowledge of accreditation and licensing requirements and must be a resource to staff on these regulations in order to improve management of outcomes and ensure compliance. Assists with regulatory readiness and survey preparation activities including mock survey tracers. Provides consultation and assists physicians, ancillary and nursing departments with regulatory compliance issues. Supports implementation of regulatory initiatives.- Provides leadership to the Quality Management Department; hires, supervises, and monitors staff performance and productivity. Contributes to the budgeting process. Educates and trains staff and physicians in quality improvement including the aggregation and analysis, action planning and reporting of performance data.- Works in collaboration with hospital leadership and medical staff to meet goals established in the Performance Improvement plan. Actively participates on, or facilitates committees such as: Quality Improvement, Utilization Management, Patient Safety, and Risk Management.- Effectively manage financial resources within the area(s) of responsibility including labor management, productivity, supplies, and other resources. ***This position is mainly work from home within California, but will have the possibility of some travel to provider offices in the Central CA and Ventura regions. Job Requirements Minimum Qualifications: - 5+ years of relevant experience.- 3+ years of supervisory and/or management experience, including at least 1 year managing the organization's Quality Improvement program.- Bachelors degree in a healthcare related field, or 5 years of related job or industry experience in lieu of degree.- Experience with quality improvement methodology and data analysis- Experience developing and implementing clinical, service and operational process improvement initiatives, both small and large scale.- Experience with Joint Commission Standards and Regulatory Compliance of Other Agencies. Preferred Qualifications: - Previous experience with managing a HEDIS quality program strongly preferred. - Masters degree in healthcare administration or business administration preferred.

Where You’ll Work The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric, full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health’s Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups, hospitals, health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first. Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art, flexible Health & Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options, including medical, dental and vision plans, for the employee and their dependents, Health Spending Account (HSA), Life Insurance and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave. One Community. One Mission. One California Job Summary and Responsibilities The Appeals and Grievances Supervisor is responsible for managing and coordinating the appeals and grievance process within Dignity Health MSO. The Supervisor will lead a team of coordinators providing guidance, training, and support to ensure the highest standards of patient service and regulatory compliance.This role involves handling member and provider complaints, ensuring compliance with regulatory requirements, and facilitating timely and effective resolution of appeals and grievances. Acting a subject matter expert (SME), the Supervisor will work closely with internal teams and external stakeholders to ensure a high level of service and satisfaction. The Supervisor oversees a mix of operational, business and regulatory activities related to several Health Plan Partnerships. This position will work closely with health plan partners to ensure a seamless transition in implementing new and ongoing regulatory requirements. From a business perspective, this role is responsible for the ongoing delegation and performance of our contractual obligations. - Supervise a team of appeals and grievances coordinators. Develop and implement strategies to improve team performance and efficiency.- Receive, document, and manage member and provider appeals and grievances in accordance with Dignity Health MSOs organizational policies and regulatory standards. Ensure all cases are processed within required timeframes and follow-up actions are completed properly. Prepare and present reports on appeals and grievances activity to senior management.- Maintain detailed and accurate records of all appeals and grievances, including documentation of investigations, outcome, and communications.- Manages and works closely with Regulatory partners in the management of identified patient populations. Oversees a mix of operational, clinical, educational and business activities as they relate to this partnership.- Conducts relevant research into complaints and collaborates, coordinates and communicates with various departments (i.e. Member Services, Care Management, Claims), as well as external entities (i.e. Providers and Vendors) to collect additional information as necessary.- Monitor and analyze trends in appeals and grievances to identify systemic issues and recommend corrective actions. Prepare and submit regular reporting on appeals and grievance activity, trends, and outcomes to management and regulatory agencies as required. ***This position is remote within California. Job Requirements Minimum Qualifications: - 3+ years of experience in healthcare appeals and grievances, with at least 2 years in a supervisory or leadership role.- Associates degree or 3 years of related job or industry experience in lieu of degree.- Familiarity with healthcare regulations, including HIPAA, CMS, and state-specific requirements. Preferred Qualifications: - Previous appeals and grievances experience at a health plan, managed care organization and IPA strongly preferred. - Previous experience in claims, UM or provider relations a plus.- Bachelors degree in a relevant field (e.g., healthcare management, business administration, compliance) or 5 years of related job or industry experience in lieu of degree preferred.- Knowledge of DMHC, NCQA, CMS and other regulatory bodies preferred.- Strong technical proficiency in data analysis; database software preferred.- Regulatory audit experience preferred.- Certified Compliance Professional, Certified Professional in Healthcare Quality, or Certified Healthcare Auditor preferred. #LI-DH

Where You’ll Work The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric, full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health’s Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups, hospitals, health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first. Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art, flexible Health & Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options, including medical, dental and vision plans, for the employee and their dependents, Health Spending Account (HSA), Life Insurance and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave. One Community. One Mission. One California Job Summary and Responsibilities As a Coder, you will ensure precise communication with insurance companies so that services are documented correctly and payments are processed efficiently. Every day you will accurately translate patients’ medical records into standardized codes for diagnoses and treatments. Using your expertise and training, you will ensure compliance with legal, regulatory, and organizational standards. To be successful in this role, you must combine accuracy and attention to detail with a strong knowledge of coding standards and healthcare regulations. Clear communication with providers and staff, along with efficient management of records, ensures claims are processed correctly and on time. - Review patient medical record information via population health tools on both a retroactive and prospective basis to identify, assess, monitor and review network coding opportunities as it pertains to risk adjustment. - Ensure that the diagnosis codes for each chronic or major medical condition have been captured and work to educate providers on opportunities to improve documentation on medical conditions. - Review clinical documentation across the network to identify patterns and trends in clinical documentation. Work with network providers to improve clinical documentation to better support CMS Risk Adjustment guidelines. - Develop education materials and tools to help network providers improve clinical documentation and support Hierarchical Condition Category (HCC) coding capture. - Participate network performance improvement initiatives. - Safeguards medical records and preserves the confidentiality of personal health information through the observance of physician network policies pertinent to the release of medical record information, record retention, and HIPAA privacy and security. ***This position is remote. Job Requirements Minimum Qualifications: - Associates degree or equivalent work experience- CPC, CRC, CCS, CCS-P, or RHIT- Advanced knowledge of CPT and ICD-10 coding- Knowledge of federal and state guidelines on all coding systems and sponsored programs.- Familiarity and understanding of CMS HCC Risk Adjustment coding and data validation requirements.- Must possess the ability to work independently with strong organizational, communication and interpersonal skills to support the management of multiple priorities, at multiple practice locations, with significant attention to detail for completion of both verbal and written external communications.- Computer literacy of medical information system, records management software, encoders.- Must have excellent verbal communication skills.- Proficiency in MS office (Outlook, Excel, Word). Preferred Qualifications: - 2-3 years of experience in risk adjustment/HCC coding strongly preferred

Where You’ll Work The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric, full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health’s Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups, hospitals, health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first. Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art, flexible Health & Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options, including medical, dental and vision plans, for the employee and their dependents, Health Spending Account (HSA), Life Insurance and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave. One Community. One Mission. One California Job Summary and Responsibilities As the Continuing Care LVN Coordinator, you will perform patient care management services that support the established plan of care as directed by the other licensed staff within the department. Every day, you will assist in relaying instructions from the physician to a patient or authorized person, as well as collecting patient data, documenting patient concerns, patient messages, and any instructions or education provided within the care management operational platform. The LVN will also provide leadership to support staff. To be successful, you will demonstrate outstanding assessment and communication skills, critical thinking, time-management and strong relatioship-building skills. - Conducts telephonic screenings based on criteria, refers patients to healthcare programs, specialists and other multidisciplinary team members such as a diabetes health educator, home visit provider, geriatric clinic, home health, pharmacist, etc. As per guidelines and or red flag criteria escalates to the RN or SW or supervisor when patient needs or concerns are beyond his/her scope of practice. - Assist patients and or caregivers in achieving compliance and improving adherence to plan of care notifying RN/SW or provider of issues and collaborating with multidisciplinary team members (primary care physician, social workers, pharmacists, home visit providers, etc) based on the patient's established plan of care. - Coach's patients, family and/or caregivers about the disease process including how to recognize signs and symptoms of worsening disease and next steps. Based on care plan or program criteria, identifies appropriate cases to discontinue from the program and collaborates with SW and RN to document rationale accordingly. - Serves as an advocate and liaison between patient/family and physician, hospital staff, members of the health care team, clinic care coordinators, and community resources. - Monitors member's compliance with scheduling and keeping PCP and specialist appointments identifying patterns of nonadherence and coordinates scheduling of needed member appointments. - Assists patients with navigating the healthcare system to minimize fragmentation in services, obtain timely care and appropriate access to providers, services and necessary procedures, escalating patients as per scope of practice. ***This position is work from home in California, with a preference for candidates residing in the Ventura region. Job Requirements Minimum Qualifications: - 2 years relevant experience or advanced degree required.- Graduate of an accredited LVN school.- Clear and current CA Licensed Vocational Nurse (LVN) license.- Excellent computer skills and ability to learn new systems- Strong organizational (time management) and interpersonal skills- Ability to handle multiple priorities with strong attention to detail- Ability to communicate effectively using written and verbal skills. Proficient in email communications and internet usage along with basic use of Microsoft Excel and Word- Knowledge of information technology to evaluate care effectiveness (care process, outcomes and cost)- Ability to work autonomously within a matrix environment without direct supervision or support Preferred Qualifications: - Previous care coordination experience strongly preferred. - 5+ years experience preferred. - Disease management experience a plus. - Proficiency with EHR's a plus. - Experience with Google Workspace a plus. - Bilingual in English/Spanish preferred.

Where You’ll Work The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric, full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health’s Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups, hospitals, health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first. Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art, flexible Health & Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options, including medical, dental and vision plans, for the employee and their dependents, Health Spending Account (HSA), Life Insurance and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave. One Community. One Mission. One California Job Summary and Responsibilities As the Continuing Care LVN Coordinator, you will perform patient care management services that support the established plan of care as directed by the other licensed staff within the department. Every day, you will assist in relaying instructions from the physician to a patient or authorized person, as well as collecting patient data, documenting patient concerns, patient messages, and any instructions or education provided within the care management operational platform. The LVN will also provide leadership to support staff. To be successful, you will demonstrate outstanding assessment and communication skills, critical thinking, time-management and strong relatioship-building skills. - Conducts telephonic screenings based on criteria, refers patients to healthcare programs, specialists and other multidisciplinary team members such as a diabetes health educator, home visit provider, geriatric clinic, home health, pharmacist, etc. As per guidelines and or red flag criteria escalates to the RN or SW or supervisor when patient needs or concerns are beyond his/her scope of practice. - Assist patients and or caregivers in achieving compliance and improving adherence to plan of care notifying RN/SW or provider of issues and collaborating with multidisciplinary team members (primary care physician, social workers, pharmacists, home visit providers, etc) based on the patient's established plan of care. - Coach's patients, family and/or caregivers about the disease process including how to recognize signs and symptoms of worsening disease and next steps. Based on care plan or program criteria, identifies appropriate cases to discontinue from the program and collaborates with SW and RN to document rationale accordingly. - Serves as an advocate and liaison between patient/family and physician, hospital staff, members of the health care team, clinic care coordinators, and community resources. - Monitors member's compliance with scheduling and keeping PCP and specialist appointments identifying patterns of nonadherence and coordinates scheduling of needed member appointments. - Assists patients with navigating the healthcare system to minimize fragmentation in services, obtain timely care and appropriate access to providers, services and necessary procedures, escalating patients as per scope of practice. ***This position is work from home in California, with a preference for candidates residing in the Ventura region. Job Requirements Minimum Qualifications: - 2 years relevant experience or advanced degree required.- Graduate of an accredited LVN school.- Clear and current CA Licensed Vocational Nurse (LVN) license.- Excellent computer skills and ability to learn new systems- Strong organizational (time management) and interpersonal skills- Ability to handle multiple priorities with strong attention to detail- Ability to communicate effectively using written and verbal skills. Proficient in email communications and internet usage along with basic use of Microsoft Excel and Word- Knowledge of information technology to evaluate care effectiveness (care process, outcomes and cost)- Ability to work autonomously within a matrix environment without direct supervision or support Preferred Qualifications: - Previous care coordination experience strongly preferred. - 5+ years experience preferred. - Disease management experience a plus. - Proficiency with EHR's a plus. - Experience with Google Workspace a plus. - Bilingual in English/Spanish preferred.

Where You’ll Work The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric, full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health’s Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups, hospitals, health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first. Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art, flexible Health & Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options, including medical, dental and vision plans, for the employee and their dependents, Health Spending Account (HSA), Life Insurance and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave. One Community. One Mission. One California Job Summary and Responsibilities As the Credentialing Specialist, you will be responsible for all credentialing activities associated with all IPAs and product lines managed by Dignity Health MSO. Every day you will manage daily credentialing operations, including resolution of non-responsive providers. You will also work collaboratively with Credentialing leadership, Medical Directors, Provider Relations Department, Contracting Department, health plans, providers, provider office staff, and other persons or businesses as necessary to ensure that all providers are properly credentialed according to NCQA and health plan standards. To be successful in this role, you will demonstrate a comprehensive understanding of credentialing regulations and processes, possess strong organizational and communication skills, and effectively manage complex administrative tasks to ensure provider compliance and efficient operational flow. - Attend ICE Credentialing Shared Audit Team Workshops and Teleconferences on a monthly basis to keep informed of current and changing credentialing requirements and standards. Relay information to QM & Credentialing Supervisor for implementation and updates to Policies and Procedures. - Coordinate transfer of initial provider credentialing application to Credentials Verification Organization (CVO). Monitor CVO performance of initial and recredentialing on a regular basis for evaluation and intervention, if necessary, to ensure compliance with internal credentialing time frame requirements for all IPAs - Collect re-credentialing applications and associated required documents from providers who are listed on the 3rd Recred Apps Sent Report posted on CVO website. Upon receipt, forward to CVO for processing. - Review all applications returned by CVO for accompanying documents and completeness. Request additional information from CVO or provider as needed. Reconcile monthly statement from CVO and forward to Finance Department with payment request. Notify CVO if statement is inaccurate and adjustments need to be made prior to forwarding to finance for payment. - Perform internal primary source verifications and full credentialing for those providers who are to be credentialed on a RUSH basis. RUSH status is to be determined by administration including CEO and Medical Directors. - Notify Provider Relations Department of need for site visits. Provide Site Visit Audit Tool and copies of Physician Office Policies and Procedures for Provider Relations to give to new providers at time of site visit. ***This position is work from home within California. Job Requirements Minimum Qualifications: - 3-5 years of experience in the healthcare industry required, preferably with experience in credentialing.- High School diploma or GED.- Strong written and verbal communication skills, excellent organizational skills, and proficient in Microsoft Word, Excel, and Microsoft Outlook.- Self-directed and able to work independently under tight time frames.- Able to interact with co-workers, managers, supervisors, and administrators in a manner that promotes a positive work environment Preferred Qualifications: - 1+ years of vocational or college coursework preferred.- Certified Provider Credentialing Specialist (CPCS) or Professional Medical Services Manager preferred. - Experience with Catcus preferred. - Experience with managed care credentialing strongly preferred.

Where You’ll Work The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric, full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health’s Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups, hospitals, health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first. Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art, flexible Health & Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options, including medical, dental and vision plans, for the employee and their dependents, Health Spending Account (HSA), Life Insurance and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave. One Community. One Mission. One California Job Summary and Responsibilities ***This position may be filled as a Level I or Level II, dependent upon the final candidate's experience. As the Enrollment Technician, you will coordinate and oversee the membership enrollment process for various health plans. This role involves reconciliation of membership data against capitation payments received from delegated health plans, assisting with enrollment issues, and supporting department goals through leadership in data integrity and workflow optimization.Every day you will expertly assist health plans and employer groups, verify documentation, clarify program requirements, and meticulously process applications, ensuring accuracy and compliance with all established guidelines.To be successful, you will demonstrate outstanding communication skills, strong attention to detail, and the ability to manage multiple priorities. - Oversees the processing of enrollment and eligibility files for all lines of business, ensuring high-quality standards are maintained. - Reconciliation of membership data against capitation payments from delegated lines of business, identifying discrepancies and implementing corrective actions. - Acts as a primary point of contact with health plans and employer groups to resolve questions on member enrollment, including escalated issues. - Verifies and validates data sets, such as Primary Care Physicians, effective dates, member coverage, and plan benefits, providing support to junior team members. Maintains, processes, and audits eligibility files within the database to ensure the highest levels of data integrity and accuracy. - Supports Configuration partners (Contracting and Benefits) to streamline processes and enhance departmental efficiencies - Develops and maintains process documentation and training materials, assisting in training new staff and mentoring junior colleagues (as a Level II). ***This position is work from home within California. Job Requirements Minimum Qualifications: - 3-5+ years of experience in an administrative role with related experience (e.g., office administration support, insurance services, customer service, etc.).- Demonstrated experience in handling complex enrollment and eligibility processes (as a Level II).- High School diploma or GED (for Level I) or Associates Degree in a relevant field (e.g., healthcare management, business administration) or 3 years of related job or industry experience in lieu of degree (for Level II). Preferred Qualifications: - 3-5+ years of experience in the Managed Care/Healthcare Industry preferred. - Experience with HMO health plans preferred. - Experience navigating health plan portals preferred. - Experience with EZCap preferred. - Experience with Google Workspace a plus.- Experience with process improvement methodologies (e.g., Lean, Six Sigma) preferred.- Bachelors Degree in Business Administration or a related field preferred.- Certification in Healthcare Administration or Managed Care preferred.- Advanced Excel skills, including pivot tables, VLOOKUP, and data analysis functions.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description As the Manager, Clinical Quality Improvement, you will lead a team of dedicated LVNs/RNs in support of organizational quality improvement initiatives across Medicare, Medicaid and Commercial space. You will partner with other departments, health plans and providers to develop and monitor quality improvement plans, and report out to leaders. This position offers the opportunity to not only engage at the local level, but also engage at a system/national level in the population health space. - Negotiate project timelines, coordinate action plans, and analyze results to align with strategic goals. - Collaborate with medical groups and health plans, establishing and maintaining quality improvement programs. - Lead QI committees, ensuring compliance with regulatory standards (DMHC, DHCS, CMS, NCQA). - Manage QI documentation like the Work Plan, Program Description, and Annual Evaluation. - Identify and address programmatic weaknesses through Corrective Action Plans, driving ongoing improvement. - Conduct data analysis in collaboration with IT, defining outcome benchmarks, and developing performance dashboards. - Oversee critical programs such as HEDIS submissions, CMS Stars, and Pay for Performance. - Lead, develop, and present to senior leadership, managing both office-based and remote QI staff. - Drive change and ensure sustained quality across all clinical operations. This position is work from home within California. Qualifications - Clear and current CA Registered Nurse (RN) or Licensed Vocational Nurse (LVN) license. - 5 years of Quality Management experience in managed care health plan setting or medical group. - 5 years of oversight and management of clinical and non-clinical quality management staff. - 3 years HEDIS measures reporting and experience in CMS Stars, P4P, ACO and Value Based Payment Programs. - 3 years Medical record review project management. - Bachelors degree or equivalent in health sciences or related field. - Knowledge of quality improvement tools and methodology, such as PDSA, Lean, Six Sigma, and Statistical Process Control Analysis. - Ability to work collaboratively with physicians, staff and external organizations to improve quality outcomes. - Strong communication and presentation skills; training/meeting facilitation skills a plus. - Strong team building and interpersonal skills. - Ability to utilize sound judgment and promptly report potential risks. Requirements - 2 years of clinical experience in an acute care setting, long term care facility or home health care preferred. - Masters degree preferred. - Certified Professional in Healthcare Quality (CPHQ) or Certified Mastered Black Belt or Lean Six Sigma Black Belt Certification or Six Sigma Black Belt preferred. - Experience with medical risk adjustment preferred. Benefits - Outstanding Total Rewards package that integrates competitive pay with a flexible Health & Welfare benefits package. - Cafeteria-style benefit program with options including medical, dental and vision plans for employees and their dependents. - Health Spending Account (HSA), Life Insurance, and Long Term Disability. - 401k retirement plan with a generous employer-match. - Paid Time Off and Sick Leave.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description As the Supervisor, Continuing Care, you will manage daily operations for the assigned department(s), focusing on: - Clinical resource management - Transitions of care across the continuum - Patient advocacy - Best practice in medical and social necessity determination You will be responsible for ensuring efficient, compliant, and quality patient services. Key duties include: - Assigning tasks - Resolving minor disputes - Optimizing staff productivity and collaboration - Program development and alignment for the Enhanced Care Management (ECM) program across California This role involves: - Supporting and coaching staff - Contributing to staff evaluations - Conducting audits - Leading performance improvement activities The Supervisor collaborates with Continuing Care leadership, ensures adherence to organizational objectives, and complies with federal, state, and accrediting body regulations. They also: - Facilitate communication with colleagues and customers - Manage staff performance - Provide training - Assist with hiring and onboarding The Supervisor plays a crucial role in: - Streamlining patient transitions - Managing high-risk patients - Preparing the department for accreditation surveys - Identifying areas for improvement and implementing operational changes ***This position is remote (with a preference for residents of California or Arizona), with an expectation of 25% travel throughout California. Qualifications - 3+ years in care coordination, case management, quality, or other outpatient clinical/operations experience - Bachelor's degree or equivalent experience - Ability to manage and work closely with interdisciplinary partners in the management of identified patient populations - Demonstrated ability to oversee a mix of clinical, operational, and business activities related to the team(s) - Ability to implement specific program goals including high priority project redesign efforts required to improve performance - Ability to work in partnership with all applicable internal and external customers focused on services to patients - Ability to assess and report patient status on a periodic basis to all team stakeholders - Excellent computer skills and ability to learn new systems - Strong organizational (time management) and interpersonal skills - Ability to communicate effectively using written and verbal skills - Knowledge of information technology to evaluate care effectiveness (care process, outcomes, and cost) - Knowledge of federal and state standards and regulatory requirements as well as accreditation requirements - Ability to work autonomously within a matrix environment without direct supervision or support - Ability to handle multiple priorities with strong attention to detail - Demonstrated ability to set goals either for themselves or others Requirements - Knowledge of/experience with CA Medi-Cal program strongly preferred - Previous experience with Enhanced Care Management (ECM) program preferred - Previous project management experience preferred Benefits - Competitive pay - Flexible Health & Welfare benefits package - Cafeteria-style benefit program - Medical, dental, and vision plans for employees and their dependents - Health Spending Account (HSA) - Life Insurance and Long Term Disability - 401k retirement plan with a generous employer-match - Paid Time Off and Sick Leave

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description As our Program Manager, you will lead the project development life cycles for key strategic ambulatory/population health quality initiatives, bridging strategy with execution under the direction of assigned senior leader(s). - Work closely with leadership, serving as a Business Sponsor for projects. - Partner with administration on strategy development and annual planning, focusing on growing program offerings and achieving competitive advantage within our service lines. - Drive tactical plans, manage projects to completion, and provide timely information through opportunity identification and in-depth analyses. - Integrate tasks across functional areas, define clear requirements, manage timelines, assemble stakeholders, assign responsibilities, and report/present to PMO, project teams, and senior leadership. - Possess exceptional project and program management skills, a strategic mindset, and a proven ability to drive complex initiatives from conception to completion. - Collaborate effectively, provide insightful analysis, and ensure timely, successful project delivery to achieve strategic objectives. - Manage assigned projects and communicate and document the status of project activities to applicable leadership. - Manage multiple strategic and operational projects of medium-to-large size, complex and people, process and technology impacts through the entire Project Development Lifecycle from kick-off to completion. - Establish and maintain project plans and project budgets, report progress as required, generate risk assessments, escalate issues, and facilitate project review presentations. - Contribute to thoughtful and creative discussions with project sponsor(s), stakeholders, department and division management on strategic goals, resources, scheduling, plans and challenges. - Manage the day-to-day projects/logistics, which includes developing, reviewing, and revising project management processes, managing timelines, schedules, and project documentation to ensure all steps are completed efficiently. - Facilitate meetings related to projects and send corresponding communication for each project. This position is remote, but will be expected to work PST business hours. Qualifications - 3-5 years executive healthcare administration related experience. - Bachelors in Business Administration/Finance/Accounting or equivalent combination of education and experience. - Advanced knowledge in MS Office (Word, Excel, PowerPoint). Requirements - Experience with HEDIS and/or Medicare STARS strongly preferred. - Experience with data analytics and working with multiple data sources strongly preferred. - Knowledge of CAHPS preferred. - Knowledge of medication adherence preferred. - Masters in Business Administration or Healthcare Management preferred. - Project Management experience preferred. Benefits - Competitive pay with a state-of-the-art, flexible Health & Welfare benefits package. - Cafeteria-style benefit program allowing employees to choose benefits from a variety of options, including medical, dental, and vision plans for the employee and their dependents. - Health Spending Account (HSA). - Life Insurance and Long Term Disability. - 401k retirement plan with a generous employer-match. - Paid Time Off and Sick Leave.