Manager, Provider Quality Oversight
Employment Information
Report this job
Job expired or something wrong with this job?
Job Description
Manager of Provider Quality Oversight at Inland Empire Health Plan leading quality initiatives. Responsible for overseeing quality assurance and compliance in healthcare processes.
Responsibilities:
- Leading the daily operations of the Potential Quality Incident/Provider Preventable Condition and clinical reporting nurse teams.
- Ensure the complete review of Quality-of-Care cases, adherence to standard work, reporting accuracy, and compliance with IEHP policies, Local, State, and Federal laws, and regulations.
- The planning and implementation of any quality audit initiatives, programs, and processes identified by IEHP’s Quality System.
- Responsible for managing direct reports to ensure effective resource management and prioritization of work in support of meeting Quality and Organizational goals and priorities.
- Responsible for the development, management, implementation, and evaluation of all areas of responsibility including, but not limited to, Potential Quality Incidents (PQI)/Provider Preventable Conditions (PPC) processes, Quality Reviews, and clinical audits of IEHP Providers to ensure clinically appropriate billing.
- Provide oversight and management of the PQI and PPC processes and staff to comply with IEHP policies, Local, State, and Federal standards, and regulations.
- Collaborate with appropriate internal and external departments, team members, and entities to achieve organizational quality initiatives, as assigned.
- Responsible for the development, maintenance, implementation, and adherence to departmental policies and procedures, standard operating procedures, and job aides.
- Participate in Quality Management activities and projects to ensure interventions meet project goals.
- Lead, prepare, and coordinate appropriate Provider Quality Review department related internal meetings.
- Represent IEHP in external meeting related to key areas of responsibility as appropriate.
- Ensure the privacy and security of PHI (Protected Health Information) as outlined in IEHP’s policies and procedures relating to HIPAA compliance.
Requirements:
- Five (5) or more years of any individual or combined healthcare experience in quality management, quality assurance, quality improvement, utilization management, case management, acute care, and/or ambulatory care setting
- Three (3) or more years of experience in a supervisory or leadership role in any healthcare setting
- Experience in an HMO or Managed Care setting is preferred
- Bachelor's degree in Nursing from an accredited institution required
- Master's degree in Nursing from an accredited institution preferred
- Possession of an active, unrestricted, and unencumbered Registered Nurse (RN) license issued by the California BRN required
- Certified Professional in Healthcare Quality (CPHQ) certification preferred
- Knowledge of clinical audits, including medical record reviews
- Intermediate knowledge of word, excel, and PowerPoint.
- Intermediate computer skills
- Excellent verbal and written communication skills
- Builds effective work relationships
Benefits:
- CalPERS retirement 457(b) option with a contribution match
- Generous paid time off- vacation, holidays, sick
- State of the art fitness center on-site
- Medical Insurance with Dental and Vision
- Paid life insurance for employees with additional options
- Short-term, and long-term disability options
- Pet care insurance
- Flexible Spending Account – Health Care/Childcare
- Wellness programs that promote a healthy work-life balance
- Career advancement opportunities and professional development
- Competitive salary with annual merit increase
- Team bonus opportunities
Similar Jobs
Senior Channel Development Manager
Senior Channel Development Manager responsible for driving strategic growth and channel engagement in cybersecurity technology. Join X-PHY in redefining industry standards and safeguard the digital world.
Contracts Manager – Part Time
Contracts Manager overseeing the full lifecycle of company contracts including negotiations and compliance. Role requires experience in government contracting and strong regulatory knowledge.
General Manager
Dynamic Country Manager leading establishment and growth of Dandy Mexico. Building a dental operating system for practices globally through technology and support.
Senior Manager, Phones Implementation
Senior Manager of Phones Implementations leading a team to deploy VoIP solutions for veterinary clinics. Ensuring seamless onboarding and collaborating with cross-functional teams for efficiency.
Behavioral Health Care Manager
Behavioral Health Care Manager providing remote care and support to patients at Mindoula Health. Fostering therapeutic environments and facilitating interpersonal skills for patient treatment.
Resource Delivery Manager
Resource Delivery Manager at Snowflake managing staffing for professional services across North America. Focused on utilizing resources efficiently and driving best practices for service delivery.
Manager, Asset Management
Manager overseeing safe and optimized operation of renewable energy portfolio, focusing on HSSE performance and regulatory compliance. Collaborating with teams to achieve production and financial targets.
Government Lending Annual Servicing Manager
Government Lending Annual Servicing Manager responsible for managing financial servicing tasks for Government Loan Portfolio. Engaging with clients for financial updates and collaborating with internal teams.
Manager – Client Coding Integration
Manager of Client Coding Integration at Ensemble providing strategic direction for coding operations. Overseeing client coding processes and collaborating with leadership for enhanced service delivery.
Licensed Vocational Nurse, In-Patient Case Manager
LVN Case Manager coordinating care for patients in hospital or Skilled Nursing Facilities. Also collaborating with interdisciplinary teams to ensure high-quality patient management in acute care settings.
Senior Manager, Store and Veterinary Hospital Development Projects
Sr. Manager ensuring proper organization on new, remodel, and vet hospital store openings. Collaborating with departments to oversee project metrics and improvement processes.
Field Access Manager – Northeast
Field Access Manager responsible for patient access education and reimbursement support for Averitas products. Collaborating with key stakeholders and ensuring compliance across patient services.
Virtual Field Access Manager – vFAM
Virtual Field Access Manager educating provider offices on access resources for patients remotely. Collaborating with stakeholders to facilitate access and addressing challenges for QUTENZA and Averitas products.
Consultative Coding Manager
Consultative Coding Manager at CenterWell extracting clinical information and assigning medical codes from various records. Collaborating with other managers and ensuring proper coding practices.
Direct Bill Manager
Direct Bill Manager at The Hilb Group managing revenue and expense accuracy through statement reviews. Collaborating with team and clients to ensure timely postings and compliance with financial reporting.
Customer Analytics Manager
Manager of Customer Analytics leading data-driven insights for Tulip's retail SaaS product. Working collaboratively across teams to drive analytics and customer success in retail environments.
Senior Development Manager
Senior Development Manager leading Vot-ER's fundraising operations through donor engagement and project management. Collaborating with the Development team to build a strong network for civic engagement.
Health and Safety Manager
Health & Safety Manager responsible for ensuring safe operations at multiple event venues in Glasgow. Managing daily safety tasks and collaborating with project teams throughout event duration.
Project Delivery Manager – MBAN Interns
Intermediate Project Delivery Manager for SimpliCity, a Canadian GovTech startup managing technical projects and onboarding municipal partners. Focused on improving municipal digital services and application implementation.
DMEAL Manager – DDP
DMEAL Manager overseeing DDP framework and supporting program activities. Involvement in donor reporting and community engagement.