clinical quality coordinator

Summit Health

<div><h1 class="jobSectionHeader"><b>About Our Company</b></h1><p>
We&rsquo;re a physician-led, patient-centric network committed to simplifying health care and bringing a more connected kind of care.</p><p></p><p>
Our primary, multispecialty, and urgent care providers serve millions of patients in traditional practices, patients' homes and virtually through VillageMD and our operating companies Village Medical, Village Medical at Home, Summit Health, CityMD, and Starling Physicians.</p><p></p><p>
When you join our team, you become part of a compassionate community of people who work hard every day to make health care better for all. We are innovating value-based care and leveraging integrated applications, population insights and staffing expertise to ensure all patients have access to high-quality, connected care services that provide better outcomes at a reduced total cost of care.</p><p></p><p><b>
Please Note: </b>We will only contact candidates regarding your applications from one of the following domains: @summithealth.com, @citymd.net, @villagemd.com, @villagemedical.com, @westmedgroup.com, @starlingphysicians.com, or @bmctotalcare.com.</p><p></p><h1 class="jobSectionHeader"><b>
Job Description</b></h1><div><div><p>
Summit Health is seeking a Clinical Quality Coordinator, Licensed Practical Nurse (LPN) to join the <b>Internal Medicine</b><b> </b>department.</p></div><p></p><div><p><b><br>
Overview:</b></p></div><div><ul><li><p>
Coordinates compliance with Clinical Quality Requirements required for ACO/PCMH at Summit Health in conjunction with the Director of Clinical Operations.</p></li></ul></div><div><ul><li><p>
Actively participates in concurrent and retrospective case review to assure that evidence based best practices are implemented timely for patients.</p></li></ul></div><div><ul><li><p>
Tracks compliance of quality measures and provides physician and staff education relating to the externally reported measurements.</p></li></ul></div><div><ul><li><p>
Assists in the planning and implementation of interventions to ensure evidence-based practices are followed (i.e. Preventive Measures for colorectal and breast screening, vaccinations, Disease Management for Diabetes, Hypertension and Hyperlipidemia, and any other identified Gap in care).</p></li></ul></div><div><ul><li><p>
Works closely with providers, support staff and other members of the organization by demonstrating effective communications, teaching and negotiating skills.</p></li></ul></div><div><ul><li><p>
Is accountable for quality assessment and efficient coordinated care.</p></li></ul></div><div><ul><li><p>
Coordinates the day-to-day review of patient flow as part of a healthcare team by assisting in planning and implementing care interventions while promoting high quality patient care in a professional, efficient and safe manner.</p></li></ul></div><div><ul><li><p>
Directs the team member as needed in order to support and maintain high-quality patient care. Leads team huddles regarding patient care.</p></li></ul></div><div><ul><li><p>
Provides assistance with referrals to Palliative Medicine and Case Management as well as site specific injection schedules.</p></li></ul></div><div><ul><li><p>
Expected to keep relevant knowledge up-to-date and apply it to everyday practice.</p></li></ul></div><div><ul><li><p>
Effectively communicates with all team members to support a cohesive work environment.</p></li></ul></div><p></p><div><p><b><br>
Essential Functions and Job Responsibilities:</b></p></div><div><ul><li><p>
Based on Dashboard Metrics, reviews each patient's plan of care to ensure that all quality metrics are being met, including those related to Preventive Measures, Disease Management, Gaps in care, medications, diagnostic testing, education, and other areas.</p></li></ul></div><div><ul><li><p>
Routinely coordinates interdisciplinary care rounds with physicians, mid-level providers, support staff, case managers, respiratory therapists, pharmacists, dietitians, and other appropriate Summit Health personnel.</p></li></ul></div><div><ul><li><p>
Serve as liaison to physician: Serves as the &quot;point person&quot; who communicates and assists with understanding of dashboard metrics and opportunities to improve patient care, internal processes and work flows to the physician and also rounds with physicians to discuss the patient's clinical status and ensure that critical information is shared.</p></li></ul></div><div><ul><li><p>
Facilitate quality improvement, including identification and dissemination of best practices: Reviews data and trends from reports generated by Summit Health to determine system performance related to patient outcomes and then suggest areas for improvement. For example, review adherence with ACO, NCQA and contractual reporting requirements compared with the EMR. Identifies education, workflow, process or documentation/template enhancements. The coordinator meets with RN Clinical Manager, and/or Director of Clinical Operations to discuss individual nurse performance issues and/or determine whether a system-wide performance improvement initiative is warranted. Clinical Coordinator also identifies best practices for implementation.</p></li></ul></div></div><div><div><ul><li><p>
Mentor and coach support staff: Clinical coordinator orients all new clinical staff to ACO, PCMH requirements, provides ongoing mentoring, coaching, and education to all clinical support staff members. They also conduct site-wide training and education related to topics such as Medicare Wellness, Disease Specific Competencies, Emmi, peak flow, Asthma Action plans and all other department wide performance improvement initiatives.</p></li></ul></div><div><ul><li><p>
Communicate with patient/family: to review outlier metrics and assist the facilitation of scheduling follow-up as appropriate, convey any patient and family concerns to physicians.</p></li></ul></div><div><ul><li><p>
Office Visit &ndash; Provides routine office visit care, follow up, charting, desktop management, clerical support, care coordination and patient satisfaction as needed in order to maintain optimal patient care and throughput.</p></li></ul></div><div><ul><li><p>
Other &ndash; duties as assigned.</p></li></ul></div><p></p><div><p><b><br>
GENERAL QUALIFICATION STANDARDS &amp; JOB REQUIREMENTS:</b>
</p></div><div><ul><li><p>LPN NYS license</p></li></ul></div><div><ul><li><p>
BLS certified upon hire</p></li></ul></div><div><ul><li><p>
Strong computer skills</p></li></ul></div><div><ul><li><p>
Strong organizational skills, able to multitask in fast paced environment</p></li></ul></div><div><ul><li><p>
Excellent communication skills; both written and verbal</p></li></ul></div><div><ul><li><p>
Excellent time management skills</p></li></ul></div><div><ul><li><p>
Able to identify knowledge deficits of staff/physicians regarding Dashboards and Metrics</p></li></ul></div><div><ul><li><p>
Ability to prioritize, organize and manage multiple activities with limited supervision</p></li></ul></div><div><ul><li><p>
Ability to work both independently and as part of a team</p></li></ul></div><div><ul><li><p>
Ability to think critically, motivate staff to meet department quality goals, and work with minimal supervision in a stressful environment</p></li></ul></div><div><ul><li><p>
Experience with EMR preferred</p></li></ul></div></div><br>
<p></p>
Pay Range: $33.99 - $42.50 Hourly
<p>The provided compensation range is based on industry standards and salary determinations will be made based on numerous factors including but not limited to years of experience and location of position.</p><p></p><h1 class="jobSectionHeader"><b><br>
About Our Commitment</b></h1><h2 class="jobSectionHeader"><b>
Total Rewards at VillageMD</b></h2><p>
Our team members are essential to our mission to reshape healthcare through the power of connection. VillageMD highly values the critical role that health and wellness play in the lives of our team members and their families. Participation in VillageMD&rsquo;s benefit platform includes Medical, Dental, Life, Disability, Vision, FSA coverages and a 401k savings plan.</p><p></p><h2 class="jobSectionHeader"><b>
Equal Opportunity Employer</b></h2><p>
Our Company provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to, and does not discriminate on the basis of, race, color, religion, creed, gender/sex, sexual orientation, gender identity and expression (including transgender status), national origin, ancestry, citizenship status, age, disability, genetic information, marital status, pregnancy, military status, veteran status, or any other characteristic protected by applicable federal, state, and local laws.</p><p></p><h2 class="jobSectionHeader"><b>
Safety Disclaimer</b></h2><p>
Our Company cares about the safety of our employees and applicants. Our Company does not use chat rooms for job searches or communications. Our Company will never request personal information via informal chat platforms or unsecure email. Our Company will never ask for money or an exchange of money, banking or other personal information prior to the in-person interview. Be aware of potential scams while job seeking. Interviews are conducted at select Our Company locations during regular business hours only. For information on job scams, visit, https://www.consumer.ftc.gov/JobScams or file a complaint at https://www.ftccomplaintassistant.gov/.</p></div>

Clinical Quality Coordinator - LPN

Blue Shield of California

<div>
 <strong>
  Job Description
  <br/>
  <br/>
 </strong>
 <strong>
  Your Role
  <br/>
  <br/>
 </strong>
 The Clinical Quality team oversees and is responsible of HEDIS medical record review, pursuit, and overall HEDIS submission. The Clinical Quality Coordinator, Entry will report to the Supervisor of the HEDIS Outreach Team. In this role you will be responsible for conducting provider outreach during the HEDIS season for medical record pursuit and retrieval. Also, participation in Quality initiatives involving member outreach for care gap closure. Responsible for maintaining high productivity and standard work.
 <br/>
 <br/>
 Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow &ndash; personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.
 <br/>
 <br/>
 <strong>
  Responsibilities
  <br/>
  <br/>
 </strong>
 <strong>
  Your Work
  <br/>
  <br/>
 </strong>
 <strong>
  In this role, you will:
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Initiate outbound calls to members and providers to collect information and provide care coordination assistance in obtaining services (schedule appointments, provider appointment reminders, coordinate transportation, etc.)
  </li>
  <li>
   Educate members on missing care gaps and provide encouragement to obtain missing service.
  </li>
  <li>
   Request medical records from PCP/Specialists by fax, remote EMR access or scheduled site visits as needed
  </li>
  <li>
   Manage and maintain HEDIS files and medical records
  </li>
  <li>
   Provide administrative support, including generating correspondence, organize mass mailings, coordinator schedules and training
  </li>
  <li>
   Continued development of understanding of HEDIS hybrid measures and medical record requirements for HEDIS compliance
  </li>
  <li>
   Research member claims and encounters to identify accurate pursuit information for medical record retrieval
  </li>
  <li>
   Review medical records and identify elements for compliance
  </li>
  <li>
   Create and maintain detailed logs of member and provider interactions
  </li>
  <li>
   Ability to de-escalate situations
  </li>
  <li>
   Assist in onboarding contingent workforce for HEDIS and outreach projects
  </li>
  <li>
   EMR and vendor portal medical record retrieval
  </li>
  <li>
   Developing understanding of HEDIS pursuit processes relative to pursuit systems and tracking processes
  </li>
  <li>
   Developing understanding of outreach and pursuit project intake procedures, schedules, and reporting requirements
  </li>
  <li>
   Ability to work independently in a fast-paced environment with minimal errors
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Qualifications
  <br/>
  <br/>
 </strong>
 <strong>
  Your Knowledge and Experience
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Requires a high school diploma or equivalent
  </li>
  <li>
   Requires limited knowledge of systems and procedures
  </li>
  <li>
   Typically, has limited or no prior experience
  </li>
  <li>
   Communication and interpersonal skills
  </li>
  <li>
   Must be organized with the ability to keep accurate notes and records
  </li>
  <li>
   Customer service experience is preferred
  </li>
  <li>
   HEDIS knowledge strongly preferred
  </li>
  <li>
   Critical thinking skills
  </li>
  <li>
   Knowledge of computer applications including Microsoft Word, PowerPoint and Excel. Internet knowledge with the ability to complete searches
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Hybrid Virtual Work
  <br/>
  <br/>
 </strong>
 This role allows employees to work virtually full-time, however employees will be expected to come to the office based on business need.
 <br/>
 <br/>
 <strong>
  About The Team
  <br/>
  <br/>
 </strong>
 <strong>
  About Blue Shield of California
  <br/>
  <br/>
 </strong>
 As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.
 <br/>
 <br/>
 At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.
 <br/>
 <br/>
 To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.
 <br/>
 <br/>
 Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities &ndash; join us!
 <br/>
 <br/>
 <strong>
  Our Values:
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
  </li>
  <li>
   Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
  </li>
  <li>
   Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Our Workplace Model
  <br/>
  <br/>
 </strong>
 We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility:
 <br/>
 <br/>
 <ul>
  <li>
   For most teams, this means coming into the office two days per week.
  </li>
  <li>
   Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.
  </li>
  <li>
   For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.
   <br/>
   <br/>
  </li>
 </ul>
 The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.
 <br/>
 <br/>
 <strong>
  Physical Requirements:
  <br/>
  <br/>
 </strong>
 Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.
 <br/>
 <br/>
 Please click here for further physical requirement detail.
 <br/>
 <br/>
 <strong>
  Equal Employment Opportunity:
  <br/>
  <br/>
 </strong>
 External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.
</div>


Clinical Quality Coordinator, Entry

<div><p><b>Your Role<br>
</b></p><p><br>
The Clinical Quality team oversees and is responsible of HEDIS medical record review, pursuit, and overall HEDIS submission. The Clinical Quality Coordinator, Entry will report to the Supervisor of the HEDIS Outreach Team. In this role you will be responsible for conducting provider outreach during the HEDIS season for medical record pursuit and retrieval. Also, participation in Quality initiatives involving member outreach for care gap closure. Responsible for maintaining high productivity and standard work.<br>
</p><p><br>
Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow &ndash; personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.</p></div>
<br><div><p><b>Your Work
</b></p><p><b>In this role, you will:
</b></p><ul><li>Initiate outbound calls to members and providers to collect information and provide care coordination assistance in obtaining services (schedule appointments, provider appointment reminders, coordinate transportation, etc.)
</li><li>Educate members on missing care gaps and provide encouragement to obtain missing service.
</li><li>Request medical records from PCP/Specialists by fax, remote EMR access or scheduled site visits as needed
</li><li>Manage and maintain HEDIS files and medical records
</li><li>Provide administrative support, including generating correspondence, organize mass mailings, coordinator schedules and training
</li><li>Continued development of understanding of HEDIS hybrid measures and medical record requirements for HEDIS compliance
</li><li>Research member claims and encounters to identify accurate pursuit information for medical record retrieval
</li><li>Review medical records and identify elements for compliance
</li><li>Create and maintain detailed logs of member and provider interactions
</li><li>Ability to de-escalate situations
</li><li>Assist in onboarding contingent workforce for HEDIS and outreach projects
</li><li>EMR and vendor portal medical record retrieval
</li><li>Developing understanding of HEDIS pursuit processes relative to pursuit systems and tracking processes
</li><li>Developing understanding of outreach and pursuit project intake procedures, schedules, and reporting requirements
</li><li>Ability to work independently in a fast-paced environment with minimal errors</li></ul></div>
<br><div><p><b>Your Knowledge and Experience
</b></p><ul><li>Requires a high school diploma or equivalent
</li><li>Requires limited knowledge of systems and procedures
</li><li>Typically, has limited or no prior experience
</li><li>Communication and interpersonal skills
</li><li>Must be organized with the ability to keep accurate notes and records
</li><li>Customer service experience is preferred
</li><li>HEDIS knowledge strongly preferred
</li><li>Critical thinking skills
</li>Knowledge of computer applications including Microsoft Word, PowerPoint and Excel. Internet knowledge with the ability to complete searches<br>
<li>
</li></ul><p></p><p><b>Hybrid Virtual Work
</b><br>
This role allows employees to work virtually full-time, however employees will be expected to come to the office based on business need.</p></div>
<br><p></p><div><p><b>ABOUT THE TEAM<br>
About Blue Shield of California
</b></p><p>As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.
</p><p>At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.
</p><p>To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.
</p><p>Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities &ndash; join us!
</p><p><b>Our Values:
</b></p><p></p><ul><li><b>Honest. </b>We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
</li><li><b>Human. </b>We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
</li><li><b>Courageous. </b>We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.
</li></ul><div><p><b>Our Workplace Model
</b></p><p>We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility:
</p><ul><li><p>For most teams, this means coming into the office two days per week.
</p></li><li><p>Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.
</p></li><li><p>For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.
</p></li></ul><p>The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.
</p></div><p></p><p><b>Physical Requirements:
</b></p><p>Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.</p><p><br>
</p><p><b>Equal Employment Opportunity:
</b></p><p>External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.</p></div>

University of Oklahoma

<div></div><div><div><b>Job no:</b> 492838<br>
<b>Work type:</b> Professional<br>
<b>Location:</b> Oklahoma City<br>
<b>Categories:</b> Technology/Research<br>
</div>
<div><p><b>Pay Range: </b>Targeted salary up to $60,500 based on experience and education.</p>
<p><b>
Benefits Eligible: </b>Yes</p>
<p><b>
Work Schedule: </b>Monday &ndash; Friday, 8:00 a.m. to 5:00 p.m. (may include some weekends)</p>
<p><b>
Travel: </b>Required</p>
<p><b>
For Best Consideration Date: </b>June 1, 2026</p>
<div>
<div><div><div><p><b>Position Introduction:</b></p>
<p>
Established in 2013, the Oklahoma Clinical and Translational Science Institute (OCTSI) serves as a catalyst for clinical and translational research that improves health and healthcare for Oklahomans. As a quality improvement coordinator, you will play a vital role in advancing quality, safety, and continuous improvement in patient care. This position supports quality improvement initiatives through medical record reviews, data collection and analysis, and coordination of surveys. Working closely with clinical staff and leadership, this role helps identify opportunities, improve clinical workflow, and implement quality improvement strategies to enhance patient outcomes and support a culture of excellence in primary care delivery.</p>
<p>
View full job description.</p></div></div><div><br>
<div>
<p><b>Required Education and Experience:</b></p>
<ul>
<li>Bachelor's Degree in Nursing or other Allied Health program.</li>
<li>24 months clinical health care experience in any of the following: direct patient care, medical record and clinic/site reviews, patient complaint investigator, clinical guidelines, and quality of care/risk management/patient safety issues.</li>
</ul>
<p><b>Required Certifications and Licenses:</b></p>
<p>
None</p>
</div>
</div><br>
</div></div><p><b>Hiring Contingent Upon a Background Check:</b> Yes</p>
</div>
<p><b>Advertised:</b> 06 May 2026 Central Daylight Time<br>
<b>Applications close:</b> 05 Aug 2026 Central Daylight Time</p></div><p></p>

Clinical Quality Improvement Coordinator

MCMC

<div><div><div><b>Ready for a Rewarding Career that Fits Your Lifestyle?</b>
</div></div><p></p><div><div>Imagine a job where you can keep your <b>clinical skills sharp</b>, tackle exciting challenges, AND work from the comfort of your own home. Sounds like the perfect mix, right?</div></div><p>
</p><p></p><div><div><b>MES</b> is looking for a <b>self-driven, high-performing Registered Nurse (RN) or Licensed Vocational Nurse (LVN)</b> to join our dynamic team as a <b>Clinical Quality Assurance Coordinator</b>. In this role, you&rsquo;ll ensure our <b>Peer Review case reports</b> are nothing short of exceptional&mdash;delivering top-notch quality and integrity, all while staying fully aligned with <b>client agreements</b>, <b>regulatory standards</b>, and <b>state and federal mandates</b>.</div></div><p>
</p><div><div>The position is <b>100% remote</b> with a schedule of<b> </b><b>Monday through Friday:</b></div></div><ul><li><div><b>
three days: 12-8:30PM EST
</b></div></li><li><div><b>two days: 8-4:30PM EST</b></div></li></ul><p>
</p><ul><li><div>Performs quality assurance review of peer review reports, correspondences, addendums or supplemental reviews.</div></li><li><div>
Ensures clear, concise, evidence-based rationales have been provided in support of all recommendations and/or determinations.</div></li><li><div>
Ensures that all client instructions and specifications have been followed and that all questions have been addressed.</div></li><li><div>
Ensures each review is supported by clinical citations and references when applicable and verifies that all references cited are current and obtained from reputable medical journals and/or publications.</div></li><li><div>
Ensures the content, format, and professional appearance of the reports are of the highest quality and in compliance with company standards.</div></li><li><div>
Ensure that the appropriate board specialty has reviewed the case in compliance with client specifications and/or state mandates and is documented accurately on the case report.</div></li><li><div>
Verifies that the peer reviewer has attested to only the fact(s) and that no evidence of reviewer conflict of interest exists.</div></li><li><div>
Ensures the provider credentials and signature are adhered to the final report.</div></li><li><div>
Identifies any inconsistencies within the report and contacts the Peer Reviewer to obtain clarification, modification or correction as needed.</div></li><li><div>
Assists in resolution of customer complaints and quality assurance issues as needed.</div></li><li><div>
Ensures all federal ERISA and/or state mandates are adhered to at all times.</div></li><li><div>
Provides insight and direction to management on consultant quality, availability and compliance with all company policies and procedures and client specifications.</div></li><li><div>
Promote effective and efficient utilization of company resources.</div></li><li><div>
Participate in various educational and or training activities as required.</div></li><li><div>
Perform other duties as assigned.</div></li></ul><p>
</p><div></div><div><div>If you&rsquo;re ready to make a real impact in healthcare, all while enjoying the flexibility of working remotely, we want to hear from you!
</div></div><p></p><ul><li><div>Active RN/LVN nursing license required.</div></li><li><div>
Must be a graduate of an accredited nursing program or related medical experience; bachelor's degree preferred.</div></li><li><div>
A minimum of two years clinical or related field experience; or equivalent combination of education and experience.
</div></li><li><div>Must have strong knowledge of medical terminology, anatomy and physiology, medications and laboratory values.</div></li><li><div>
Must be able to add, subtract, multiply, and divide in all units of measure, using whole numbers and decimals; Ability to compute rates and percentages.</div></li><li><div>
Must be a qualified typist with a minimum of 40 W.P.M</div></li><li><div>
Must be able to operate a general computer, fax, copier, scanner, and telephone.</div></li><li><div>
Must be knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet.</div></li><li><div>
Must possess excellent skills in English usage, grammar, punctuation and style.</div></li><li><div>
Ability to follow instructions and respond to upper managements&rsquo; directions accurately.</div></li><li><div>
Demonstrates accuracy and thoroughness. Looks for ways to improve and promote quality and monitors own work to ensure quality is met.</div></li><li><div>
Must demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed.</div></li><li><div>
Must be able to work independently, prioritize work activities and use time efficiently.</div></li><li><div>
Must be able to maintain confidentiality.</div></li></ul><p>
</p><p></p><div><div><b>MES Solutions</b> is a premier provider of independent medical examination and peer review services to the insurance, corporate, legal, and government sectors. Members of our credentialed medical panel conduct physical examinations or medical record reviews, delivering reports that assist clients in the resolution of automotive, disability, liability, and workers' compensation claims. MES has been providing services nationally since 1978 in accordance with the industry's highest standards of operating excellence and regulatory compliance.</div></div><p>
</p><p></p><div><div>Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, pregnancy, genetic information, disability, status as a protected veteran, or any other protected category under applicable federal, state, and local laws.</div></div><div><div><b>
Equal Opportunity Employer - Minorities/Females/Disabled/Veterans</b></div></div><div><div><b><i>
MES offers a fast-paced team atmosphere with competitive benefits (medical, vision, dental), paid time off, and 401k.</i></b></div></div></div>

Clinical Quality Assurance Coordinator

<div><p><b>Calling All LPNs and RNs!</b>
</p><p></p><p>Are you an LPN's and RN's looking for an exciting new opportunity? <b>MCMC</b> is on the hunt for a talented <b>Clinical Quality Assurance Coordinator</b> to join our growing team! In this role, you&rsquo;ll dive into medical records, pulling out key details and crafting detailed narrative summaries. Your keen eye for detail will make you an invaluable part of our quality assurance process.</p><p>
</p><div><b>Why You&rsquo;ll Love This Role:</b><br>
<b>-100% Remote</b> &ndash; Work from where you're most comfortable - home!<br>
<ul><li><b>Flexible Hours</b> &ndash; Monday-Friday. Start your day between 11:30am EST, and end at 8:00pm EST.</li></ul></div><p>
At MCMC, we&rsquo;re an <b>employee-first</b> company offering fantastic <b>benefits</b> and incredible <b>growth opportunities</b>. If you&rsquo;re ready to take the next step in your career with a team that values your expertise, we want to hear from you!</p><p>
</p><p>Don&rsquo;t wait&mdash;apply today and join us on this exciting journey!
</p><p></p><p><b>MINIMUM REQUIRED QUALIFICATIONS</b></p><p><b>
Education and/or Experience
</b></p><p>High school diploma or equivalent required. A minimum of two years clinical or related field experience; or equivalent combination of education and experience preferred. Knowledge of the insurance industry, preferably claims management relative to one or more of the following categories: workers' compensation, no-fault, liability, or disability preferred.</p><p><b>
Certificates, Licenses, Registrations
</b></p><p>LPN/LVN/RN may be required based on business needs.</p><p>
</p><p><b>ESSENTIAL COMPETENCIES
</b></p><p><b>QUALIFICATIONS
</b></p><ul><li>Must have strong knowledge of medical terminology, anatomy and physiology, medications and laboratory values.</li><li>
Must be a qualified typist with a minimum of 40 W.P.M</li><li>
Must have a full understanding of HIPAA regulations and compliance.</li><li>
Must be able to operate a general computer, fax, copier, scanner, and telephone.</li><li>
Must be knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet.</li><li>
Must demonstrate exceptional communication skills.</li><li>
Ability to follow instructions and respond to upper managements&rsquo; directions accurately.</li><li>
Must demonstrate accuracy and thoroughness. Look for ways to improve and promote quality and monitors own work to ensure quality is met.</li><li>
Must be able to work independently, prioritize work activities and use time efficiently.</li><li>
Must be able to maintain confidentiality.</li><li>
Must be able to demonstrate and promote a positive team -oriented environment.</li><li>
Must be able to stay focused and concentrate under normal or heavy distractions.</li><li>
Must be able to work well under pressure and or stressful conditions.</li><li>
Must possess the ability to manage change, delays, or unexpected events appropriately.</li><li>
Ability to follow all company policies and procedures in effect at time of hire and as they may change or be added from time to time.</li></ul><p><b>
LANGUAGE/COMMUNICATION SKILLS
</b></p><ul><li>Ability to read, analyze and interpret common correspondence, medical records, and legal contracts and documents.
</li><li>Ability to write clearly and informatively to all required audiences and edit own work for appropriate spelling and grammar.</li><li>
Ability to respond appropriately and professionally to all inquiries or complaints from customers, physicians, regulatory agencies, and/or members of the business community.
</li><li>Ability to effectively present information one-on-one or in small groups.</li></ul><p><b>
PHYSICAL DEMANDS
</b></p><p>The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.</p><p>
This position generally consists of:</p><ul><li>
Ability to work at a desk or similar office-type furnishings up to 8 hours a day or longer as required by business needs.</li><li>
Ability to operate a computer up to 4 hours at a time.</li><li>
Ability to travel to different floors of the office or other locations.</li><li>
Ability to move throughout the office.
</li><li>Occasionally lifting and/or carrying up to 10 lbs.</li><li>
Occasionally pushing/pulling up to 10 lbs.</li><li>
Occasionally subject to bending, squatting or twisting.</li></ul><p><b>
WORK ENVIRONMENT
</b></p><p>The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.</p><ul><li>
Extended hours are occasionally required beyond the regular eight (8) hour work day.</li><li>
The noise level in the work environment is usually moderate.<b>
</b></li></ul><p></p><p>MCMC is an Equal Opportunity Employer and affords equal opportunity to all qualified applicants for all positions without regard to protected veteran status, qualified individuals with disabilities and all individuals without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age or any other status protected under local, state or federal laws.</p><p>
</p><p><b>Equal Opportunity Employer - Minorities/Females/Disabled/Veterans</b></p></div>

HARBIN CLINIC

<div></div><div><div><div><div><div><div><div><div><h1 class="jobSectionHeader"><b>Heart &amp; Vascular Service Line</b></h1>
<p>Charlotte, NC, United States<br>
Job ID: R211015
<br>
Shift: 1st
<br>
Job Type: Regular
</p></div><div><div><div><div>Share: mail</div></div></div></div><div></div><div><br>
</div></div><p></p><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><p><b>Department:</b></p></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div>
10919 Enterprise Corporate - Quality Charlotte Area<p></p><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><p><b>
Status:</b>
</p></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div>Full time<p></p><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><p><b>
Benefits Eligible:</b></p></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div>
Yes<p></p><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><p><b>
Hou</b><b>rs Per Week:</b></p></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div>
40<p></p><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><p><b>
Schedule Details/Additional Information:</b></p></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div><p>
Monday - Friday, 1st Shift, hours may vary.</p><p></p><p><b>
Pay Range</b></p>
$38.20 - $57.30<p></p><p>
Conducts leading practice research and analytics on clinical outcomes improvement and hardwires best practices. Evaluates and analyzes clinical and financial data, communicating necessary strategies for improvement. Works collaboratively to identify and coordinate the execution of projects and initiatives for the MSKI Quality Program, which encompasses the full continuum of care. Coordinates the collection and reporting of quality data for accreditation requirements, including patient chart reviews. Fosters collegiality, teamwork, and appropriate integration of services across departments to promote a harmonious work environment and exceptional experience for the patient.</p><p></p><p>
EDUCATION/EXPERIENCE: Master's degree in Business, Nursing or Health Care Administration or a related field required with three years' experience in a healthcare provider organization. Demonstrated leadership/management experience required. Experience with CMS regulations preferred.</p><p>
LICENSURE, CERTIFICATION, and/or REGISTRATION: Clinical experience preferred. Two years' project management experience preferred. Demonstrates ability to lead and facilitate projects and teams. RN or other clinical licensure preferred, certification in health care quality, patient safety or related regular entity preferred.</p><p>
ESSENTIAL FUNCTIONS:</p><p>
Identifies and researches innovative techniques /services and outlines the necessary steps to implement changes.</p><p>
Responsible for the implementation of operational performance improvement projects for the Program and aligns with the overall vision and values.</p><p>
Ensures collaboration and integration of operations with other departmental and MSK services.</p><p>
Responsible for the ongoing program management across the continuum and locations, measures compliance with recognized standards of care and achieves operational efficiency, patient satisfaction, quality outcomes, and operational performance goals.</p><p>
Identifying and implementing patient care processes and protocols to promote appropriate utilization of resources.</p><p>
Participates in identifying needs, planning, developing and implementing educational programs for staff, patients, families and/or community groups to improve the care of patients.</p><p>
Promotes and develops personal and professional growth, maintaining professional and clinical knowledge; attends continuing education and in-services as needed. Maintains professional and clinical knowledge, acting as a resource to others.</p><p>
Serves as a clinical expert and resource assisting with care for the complex and/or highly specialized patient care situations, seeking processes to reduce length of stay, cost per patient day, and other patient care efficiencies. Assists institutional financial and operational leaders to develop and implement key projects associated with the service to include, but not limited to: Financial Bundles, Quality Bundles and Patient Satisfaction.</p><p>
Evaluation of new products, improving processes, promoting quality and safety and patient satisfaction.</p><p>
Collects, analyzes, and reports quality data to the orthopaedic department, health system committees, task forces as well as accreditation programs.</p><p>
Pursues and maintains pertinent quality certifications by overseeing adherence of quality standards and protocols as well as reporting required metrics. (JCAHO and AJRR)</p><p>
SKILLS/QUALIFICATIONS: Strong oral and written communication skills with ability to adapt to different audiences. Experience and/or training in process management and process/performance improvement methodologies. Demonstrates use of evidence-based practice to effect quality improvement. Strong time management and multi-tasking skills with ability to prioritize tasks/goals in a timely manner. Effective, strong presentation skills. Strong problem solving, team building and facilitation skills. Knowledge and skill in using computer and network systems with strong background in Microsoft Office programs. Strong analytical and quantitative skills. Solid business writing skill.</p><p>
WORK ENVIRONMENT: Possible exposure to infections and contagious diseases Occasionally subject to irregular hours Subject to many interruptions Occasional pressure due to multiple calls and inquires. Potential remote role with some in person meetings requested.</p><p></p><p><b>
Our </b><b>Commitment to You:</b></p><p></p><p>
Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more &ndash; so you can live fully at and away from work, including:</p><p></p><p><b>
Compensation</b></p><ul><li>
Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training</li><li>
Premium pay such as shift, on call, and more based on a teammate's job</li><li>
Incentive pay for select positions</li><li>
Opportunity for annual increases based on performance</li></ul><p></p><p><b>
Benefits and more</b></p><ul><li>
Paid Time Off programs</li><li>
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability</li><li>
Flexible Spending Accounts for eligible health care and dependent care expenses</li><li>
Family benefits such as adoption assistance and paid parental leave</li><li>
Defined contribution retirement plans with employer match and other financial wellness programs</li><li>
Educational Assistance Program</li></ul><p></p><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><p><b>
About Advocate Health</b></p><p></p><p>
Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation&rsquo;s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.</p></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div><p>
</p>Conducts leading practice research and analytics on clinical outcomes improvement and hardwires best practices. Evaluates and analyzes clinical and financial data, communicating necessary strategies for improvement. Works collaboratively to identify and coordinate the execution of projects and initiatives for the MSKI Quality Program, which encompasses the full continuum of care. Coordinates the collection and reporting of quality data for accreditation requirements, including patient chart reviews. Fosters collegiality, teamwork, and appropriate integration of services across departments to promote a harmonious work environment and exceptional experience for the patient.</div></div></div></div></div></div></div><div></div>

Outcomes Specialist - Heart & Vascular Service Line

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Outcomes Specialist - Heart & Vascular Service Line