clinical quality manager

Upward Health

<div><p><b>Company Overview:</b></p>
<p>
Upward Health is an in-home, multidisciplinary medical group providing 24/7 whole-person care. Our clinical team treats physical, behavioral, and social health needs when and where a patient needs help. Everyone on our team from our doctors, nurse practitioners, LCSW's, nurses, and Care Specialists to our HR, Technology, and Business Services staff are driven by a desire to improve the lives of our patients. We are able to treat a wide range of needs &ndash; everything from addressing poorly controlled blood sugar to combatting anxiety to accessing medically tailored meals &ndash; because we know that health requires care for the whole person. It's no wonder 98% of patients report being fully satisfied with Upward Health!</p>
<p><b>
Job Title &amp; Role Description:</b></p>
<p>
The <b>Manager, Quality Assurance </b>is responsible for defining and evaluating care delivery standards and ensuring consistentcyso across the organization through standardized documentation and audit practices. This role leads the organizational audit program and establishes expectations for documentation quality and patient experience across all patient-facing roles.</p>
<p>
This role evaluates clinical documentation, care delivery, workflows, and patient interactions to ensure alignment with clinical standards, regulatory requirements, and organizational expectations. Through audit insights, patient experience data, and cross-functional collaboration, the Manager identifies opportunities to strengthen care quality, improve consistency in care delivery, and enhance patient experience.</p>
<p>
The <b>Manager, Quality Assurance</b> serves as a key partner to operational and clinical leadership by translating findings into actionable recommendations that improve care delivery practices, documentation accuracy, and overall patient outcomes.</p>
<p><b>
Care Standards &amp; Quality Oversight</b>:</p>
<ul>
<li>Define and maintain standards for high-quality care delivery across all patient-facing roles</li>
<li>Establish expectations for clinical documentation, care planning, and care coordination practices</li>
<li>Evaluate appropriateness of care delivery, not just completeness of documentation</li>
<li>Promote consistency in clinical workflows and care delivery across markets and teams</li>
<li>Partner with Clinical Services Team leaders to align on best practices and standards of care</li>
</ul>
<p><b>Primary Responsibilities</b>:</p>
<p>
Audit Program Management</p>
<ul>
<li>Lead the design and management of the organizational audit program for all patient facing roles across clinical and non-clinical teams</li>
<li>Develop and maintain standardized audit tools for each role within the organization</li>
<li>Coordinate annual audit review and updates to ensure alignment with clinical standards, operational expectations, and client requirements</li>
<li>Develop new audit tools when new roles, clients, or programs are introduced</li>
<li>Maintain a centralized and organized repository for all audit tools, audit results, and historical audit documentation</li>
</ul>
<p>Chart Audits and Documentation Review</p>
<ul>
<li>Conduct routine and targeted audits of patient records and role specific documentation</li>
<li>Evaluate assessments, care plans, interventions, coordination activities, and follow up documentation for quality and compliance</li>
<li>Ensure documentation supports regulatory requirements, payer expectations, and internal care standards</li>
<li>Evaluate workflow adherence across patient facing roles to confirm alignment with established processes</li>
<li>Evaluate both quality and appropriateness of care delivery, not soley documentation completeness</li>
<li>Identify missed clinical opportunities (e.g., gaps in care planning, follow-up escalation)</li>
<li>Assess alignment between care delivered, documentation, and patient needs</li>
</ul>
<p>Audit Analysis and Reporting</p>
<ul>
<li>Track and analyze audit results across roles, programs, and markets</li>
<li>Identify patterns, risks, and opportunities for operational improvement</li>
<li>Prepare a monthly audit analysis report summarizing findings by role and program</li>
<li>Present audit findings, trends, and recommendations to senior leadership</li>
<li>Share audit outcomes directly with operational leaders responsible for the teams reviewed</li>
<li>Quality impact of documentation and workflow gaps on care quality and patient outcomes</li>
<li>Identify trends related to clinical performance, care consistency, and patient experience</li>
</ul>
<p>Training Gap Identification</p>
<ul>
<li>Identify trends that indicate knowledge gaps, workflow misunderstandings, or documentation deficiencies</li>
<li>Report training gaps and performance trends directly to employee leaders responsible for the teams reviewed</li>
<li>Provide recommendations to operational leaders on areas where additional training, guidance, or reinforcement is needed</li>
<li>Partner with leadership and training teams to support improvements in documentation practices and workflow execution</li>
<li>Support enterprise initiatives aimed at improving clinical quality, safety, and patient experience</li>
</ul>
<p>Quality Improvement Collaboration</p>
<ul>
<li>Partner with operational leaders to address audit findings and strengthen care delivery processes</li>
<li>Support development of documentation standards, job aids, and guidance when trends are identified</li>
<li>Collaborate with compliance, training, and operational teams to improve consistency in patient care practices</li>
</ul>
<p>Patient Experience &amp; Satisfaction</p>
<ul>
<li>Monitor and analyze patient satisfaction data, feedback, and experience trends across programs and markets</li>
<li>Identify themes related to patient engagement, communication, access, and care experience</li>
<li>Partner with operational and clinical leaders to address patient experience gaps and improve satisfaction outcomes</li>
<li>Incorporate patient experience insights into audit findings and clinical excellence initiatives</li>
<li>Support development of best practices for patient-centered care and engagement across roles</li>
</ul>
<p>Patient Complaints &amp; Grievance Oversight</p>
<ul>
<li>Monitor, analyze, and trend patient complaints to identify patterns related to care delivery, communication and patient experience</li>
<li>Partner with the Manager of Compliance in review, investigation, and resolution of grievances related to quality, safety, and quality of care</li>
<li>Ensure complaints and grievance insights are incorporated into audit findings, quality improvement efforts, and operational recommendations</li>
<li>Identify system issues and escalate trends that may indicate risks in care delivery, documentations practices, or patient experience</li>
<li>Collaborate with operational and clinical leadership to address root causes and drive improvements based on complaint and grievance data</li>
</ul>
<p><b>Required Qualifications:</b></p>
<ul>
<li>Active RN license required</li>
<li>BSN preferred</li>
<li>Minimum to 5 years' experience in healthcare operations, care coordination, utilization management, population health or quality improvement programs.</li>
<li>Advanced proficiency in Microsoft Excel and data tracking tools required</li>
<li>Experience conducting clinical documentation reviews or chart audits</li>
<li>Strong understanding of interdisciplinary care teams and patient care workflows</li>
<li>Experience working with electronic health records and documentation systems</li>
</ul>
<p><b>Competencies:</b></p>
<p>
Clinical Judgment:</p>
<ul>
<li>Applies clinical and operational knowledge to evaluate documentation, care delivery activities, and role performance against established standards, regulatory requirements, and organizational expectations.</li>
<li>Identifies documentation deficiencies, workflow breakdowns, and potential quality or patient safety risks through audit findings and collaborates with leadership to support corrective actions.</li>
</ul>
<p>Communication</p>
<ul>
<li>Communicates audit findings clearly with operational leaders, clinical leaders, and cross functional partners to ensure understanding of results, expectations, and improvement priorities.</li>
<li>Escalates significant audit findings or compliance risks proactively with supporting data and clear recommendations for resolution.</li>
</ul>
<p>Accountability:</p>
<ul>
<li>Takes ownership of the organizational audit program including audit tool development, audit completion, reporting timelines, and centralized documentation management.</li>
<li>Follows through on identified gaps by reporting results to employee leaders, recommending training opportunities, and monitoring improvement trends over time.</li>
</ul>
<p>Collaboration:</p>
<ul>
<li>Works closely within the Clinical Services team, Quality, Compliance, Provider Operations, Client services and leaders to ensure alignment on audit standards and improvement priorities.</li>
<li>Supports a team-based approach to strengthening documentation practices and workflow adherence by engaging leaders early when trends or training needs are identified.</li>
</ul>
<p>Operational Discipline and Organization</p>
<ul>
<li>Maintains strong attention to detail when conducting chart audits, managing audit tools, and maintaining centralized audit documentation and results.</li>
<li>Demonstrates strong prioritization and organization skills while managing multiple audit cycles, reporting deadlines, and analysis of responsibilities across roles and programs.</li>
</ul>
<p>Upward Health is proud to be an equal opportunity employer. We are committed to attracting, retaining, and maximizing the performance of a diverse and inclusive workforce. This job description is a general outline of duties performed and is not to be misconstrued as encompassing all duties performed within the position.</p><p></p><div><p><br>
Upward Health Benefits</p>
<p>
Upward Health Core Values</p>
<p>
Upward Health YouTube Channel</p></div></div><p></p>

Manager, Quality Assurance

Medical City Healthcare

<p></p><div><h5 class="jobSectionHeader"><b>Introduction</b></h5><p>
We are seeking a Nurse Manager of Quality with Medical City Alliance to promote growth and unlock possibilities. At HCA Healthcare, we are committed to the care and improvement of human life. Share your leadership skills and come make a difference with us!</p><h5 class="jobSectionHeader"><b>
Benefits</b></h5><p>
Medical City Alliance, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:</p><ul><li>
Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation.</li><li>
Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more.</li><li>
Free counseling services and resources for emotional, physical and financial wellbeing<br>
</li><li>
401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service)<br>
</li><li>
Employee Stock Purchase Plan with 10% off HCA Healthcare stock<br>
</li><li>
Family support through fertility and family building benefits with Progyny and adoption assistance.<br>
</li><li>
Referral services for child, elder and pet care, home and auto repair, event planning and more<br>
</li><li>
Consumer discounts through Abenity and Consumer Discounts<br>
</li><li>
Retirement readiness, rollover assistance services and preferred banking partnerships<br>
</li><li>
Education assistance (tuition, student loan, certification support, dependent scholarships)<br>
</li><li>
Colleague recognition program<br>
</li><li>
Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence)<br>
</li><li>
Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income.</li></ul><p>
Learn more about Employee Benefits</p><p><b><i>
Note: Eligibility for benefits may vary by location.<br>
</i></b><br>
</p><p>We are seeking Nurse Manager of Quality for our team to be an innovator. HCA Healthcare partners with Harvard Pilgrim Institute and the CDC to use our data from more than 26 million patient encounters each year to impact the industry. Come build your career with us!</p><h5 class="jobSectionHeader"><b>
Job Summary and Qualifications</b></h5><p></p><p>
The Manager of Quality is responsible for assisting the Vice President of Quality Services with tasks and activities related to the facility&rsquo;s quality improvement and survey readiness programs. Activities include assisting with the hospital accreditation program, coordinating regulatory readiness activities through the Journey to Excellence program, assisting in state, federal, and regulatory hospital compliance and reporting requirements, such as TDH, Joint Commission, CMS, OSHA, etc. The position also includes actives to assist the VP of Quality in collecting and analyzing data, compiling hospital quality reports, conducting clinical quality reviews for hospital-wide performance improvement as well as assisting with education activities pertinent to performance improvement.
</p><p><b>PRINCIPAL DUTIES/RESPONSIBILITIES:
</b></p><p></p><ul><li>Coordinates regulatory readiness activities through the Division-wide Journey to Excellence program.
</li><li>Maintains oversight of data abstraction, data entry, and data analysis for the following: Joint Commission Core Measures, CHOIS, Leap Frog and Quality Net.
</li><li>Facilitates process improvement efforts among performance improvement teams, medical staff, and hospital departments.
</li><li>Supports hospitals accreditation program and provides education to key hospital staff related to federal, state and regulatory agency requirements such as Joint Commission, CMS, TDH, OSHA, etc.
</li><li>Assists with implementation of organizational Quality Improvement Plan and associated policies and procedures.
</li><li>Collects, analyzes, and reports data through the appropriate committees assigned. Assists the VP of Quality around oversight of Medical Staff quality activities and peer review program. Collaboratively works with hospital leadership to achieve compliance with the Joint Commission core measures initiatives.
</li><li>Participates in Serious Event Analysis.
</li><li>Creates reports and analyzes information to support the performance improvement program and the Department of Quality functions and activities.
</li><li>Performs special assignments as needed/requested.</li></ul><p></p><p>
</p><p></p><h6 class="jobSectionHeader"><b>What qualifications you will need:</b></h6><p></p><p><b>
Education:</b></p><p></p><ul><li>
Bachelor of Science in Nursing required.</li><li>
Advanced degree preferred.</li></ul><p></p><p><b>
Licensure/Certification:</b></p><p></p><ul><li>
Currently licensed as a Registered Nurse in the state(s) of practice according to Law and regulation.
</li><li>Certified Professional in Healthcare Quality (CPHQ) or Certified Professional in Patient Safety (CPPS) preferred.</li></ul><p></p><p><b>
Experience:</b></p><p>
</p><p></p><ul><li>One year clinical experience in Risk Management/Quality or Clinical Leadership in an acute care facility.</li></ul><p>
Medical City Alliance serves families from Fort Worth, Keller, Haslet, Saginaw and Tarrant County. Our 99+ bed hospital offers 30+ specialties. We offer 2 convenient ER locations, including our off-campus ER in Saginaw. Our maternity floor includes labor and delivery suites and c-section ORs. We have a well-baby nursery, postpartum rooms, and a Level III NICU. We offer compassionate care with state-of-the-art surgical equipment. Our hospital offers robotic surgery to perform procedures. Our facility provides comprehensive cardiology services. We prioritize early detection and treatment of heart disease. Our advanced technology provides quick results to our patients. Our patient satisfaction scores rank in the top decile of hospitals nationwide. Our physicians rank Medical City Alliance as excellent in quality of care. We are a part of the Medical City network of hospitals. Patients are ensured access to medical experts and advanced healthcare innovations across the network.</p><p>
HCA Healthcare has been recognized as one of the World&rsquo;s Most Ethical Companies&reg; by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.</p><p></p><p><br>
&quot;There is so much good to do in the world and so many different ways to do it.&quot;- Dr. Thomas Frist, Sr.<br>
HCA Healthcare Co-Founder</p>
<p>Join our family of over 180 hospitals and about 2,000 sites of care to drive excellence and raise the bar for our over 35 million annual patient encounters.</p><p><i>
We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.</i></p></div>

Nurse Manager of Quality

DocGo

<p></p><div><p><b>Job Title: </b>Manager, Quality and Safety</p><p><b>
Location: </b>Remote</p><p><b>
Employment Type: </b>Full-time</p><p><b>
Salary: </b>$80,000- $85,000</p><p><b>
Benefits: </b>Eligible for medical, dental, vision, 401k and PTO</p><p></p><p><b>
Key Responsibilities:</b></p><p><b>
Quality &amp; Safety Program Management</b></p><ul><li>
Lead end-to-end execution of quality and safety initiatives, including planning, stakeholder alignment, timelines, and reporting.</li><li>
Develop and maintain program plans for clinical audits, quality metrics, incident reporting, and risk mitigation efforts.</li><li>
Track progress, risks, and outcomes to ensure initiatives are delivered on time and with measurable impact.</li></ul><p><b>
Data Management &amp; Reporting</b></p><ul><li>
Prepare monthly quality reports, dashboards, and partner-facing reporting deliverables.</li><li>
Generate clinician scorecards, chart review summaries, and tracking lists for clinicians under review.</li><li>
Support internal and external quality meetings by preparing materials, summaries, and performance reporting</li></ul><p><b>
Chart Review Operations</b></p><ul><li>
Identify, pull, and categorize charts for routine, priority, and focused chart reviews using established rubrics.</li><li>
Track and support chart review workflows for new and existing clinicians.</li><li>
Ensure timely completion of chart reviews and provide status updates to clinical leadership.</li></ul><p><b>
Operational &amp; Administrative Support</b></p><ul><li>
Maintain accurate quality and clinician tracking documentation across systems (including JIRA or similar tools).</li><li>
Support onboarding workflows by ensuring clinician records, quality tracking, and supervision details are up to date.</li><li>
Assist with implementation calls and provide support related to clinical quality and NP supervision requirements.</li></ul><p><b>
Tool Development &amp; Process Improvement</b></p><ul><li>
Support the development and implementation of tools to streamline quality reporting, chart review operations, and supervision tracking. Identify opportunities to automate manual processes and improve reporting efficiency.</li><li>
Partner with internal teams to enhance visibility and access to quality and supervision data.</li></ul><p><b>
Cross-Functional &amp; Partner Collaboration</b></p><ul><li>
Work closely with clinical leadership and partner-facing teams to meet ongoing reporting needs and respond to ad-hoc requests.</li><li>
Ensure partner quality requirements are supported through accurate reporting and operational execution.</li></ul><p></p><p><b>
Requirements</b></p><ul><li>
Bachelor&rsquo;s degree in Healthcare Administration, Public Health, Data Analytics, or a related field (Master&rsquo;s degree preferred).</li><li>
Minimum of 2 years of experience in clinical quality reporting and analysis, data management, or healthcare program management.</li><li>
Experience working in a healthcare environment with a focus on clinical quality, compliance, process or performance improvement.</li><li>
Excellent written and verbal communication skills, with the ability to interact effectively with clinicians, leadership teams, and external partners.</li><li>
Proven ability to work cross-functionally, partnering with clinical leadership, operations, and IT teams.</li><li>
Experience working directly with external partners and stakeholders to meet contractual obligations and reporting requirements.</li><li>
Ability to manage complex projects, including the development and implementation of new processes or systems.</li><li>
Knowledge of patient safety, adverse event reporting, and strategies to improve clinical outcomes.</li><li>
Demonstrated ability to adapt to new systems and tools quickly.</li><li>
Strong problem-solving skills with a continuous improvement mindset.</li><li>
Ability to work independently while managing multiple priorities and deadlines.</li><li>
Experience with JIRA and Looker preferred.</li></ul><p></p><p>
EEO/AAP Statement: DocGo is an equal opportunity employer. We acknowledge and honor the fundamental value and dignity of all individuals. We pledge ourselves to crafting and maintaining an environment that respects diverse traditions, heritages, and experiences. DocGo is an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.</p><p></p><p><i>
The above-noted job description is not intended to describe, in detail, the multitude of tasks that may be assigned but rather to give the applicant a general sense of the responsibilities and expectations of this position. As the nature of business demands change so, too, may the essential functions of the position.</i></p></div>

Manager, Quality and Safety

Agios Pharmaceuticals

<div><div><p><b>Senior Manager, GCP &amp; GVP, QA</b></p><p></p><p><b><br>
Who we are:</b></p><p>
At Agios, we are fueled by connections to transform rare diseases. We foster an inclusive, collaborative culture &ndash; one that sparks bold thinking and strengthens our connections with each other and with the rare disease communities we serve. We embrace diverse backgrounds with respect, active listening, and a commitment to inclusion &ndash; because our differences shape how we hire, collaborate, and innovate. Our team&rsquo;s proven track record of executional excellence, combined with our depth of expertise and dedication, enables us to develop innovative medicines that reflect the priorities of rare disease communities. Our commitment is more than scientific &ndash; it&rsquo;s deeply personal, grounded in the meaningful connections we have built. To learn more, visit www.agios.com and follow Agios on LinkedIn and X.</p><p></p><p><b><br>
The impact you will make:</b></p><p>
Agios Pharmaceuticals is searching for a dynamic <b>Sr. Manager, GCP &amp; GVP Quality Assurance (QA)</b> to join our growing GCP &amp; GVP Quality team. We want someone who cares about this important work, and who&rsquo;s driven to connect to our mission of helping these patient communities. The <b>Sr. Manager, GCP &amp; GVP QA </b>will be responsible for ensuring quality assurance and compliance of Agios Pharmacovigilance (PV) System and Agios sponsored interventional and non-interventional clinical trials in accordance with applicable Good Pharmacovigilance Practices (GVP) and Good Clinical Practice (GCP) regulatory requirements (e.g., FDA, ex-US, country specific), ICH GCP/GVP Guidelines, Agios Standard Operating Procedures (SOPs), and current industry standards and practices. They support, maintain and ensure effectiveness of quality programs and documentation to assure compliance with GVP and GCP and inspection readiness.</p><p></p><p><b><br>
What you will do:</b></p><ul><li>
Responsible for collaborating cross-functionally to develop risk-based GCP/GVP internal and external audit program and annual audit plans.</li><li>
Conduct and/or oversee consultant auditors in the conduct of GCP/GVP audits of clinical trial internal and PV processes, GCP/GVP vendors, clinical investigator sites, clinical study documents and trial master files in accordance with annual audit plans.</li><li>
Provide timely GCP/GVP quality guidance and partner with key stakeholders to resolve compliance issues and support functions in the quality event management process, protocol deviations, risk management, issue escalation and CAPA development.</li><li>
Actively participate in the Clinical Trial Working Groups (CTWG) as the Quality Representative and serve as liaison to other GxP Quality teams as needed.</li><li>
Advise teams on controlled document development to ensure adherence to ICH and GCP/GVP guidelines and alignment with Agios Quality Policy and QMS.</li><li>
Support preparation, coordination and management of Health Authority inspections including Sponsor and Investigator Site Inspections.</li></ul><p></p><p><b><br>
What you bring:</b></p><ul><li>
Bachelor&rsquo;s degree in a scientific discipline preferred or Associate&rsquo;s degree with commensurate experience; advanced degree preferred</li><li>
Minimum 4-6+ years of progressive experience working within a clinical, regulatory or quality environment in the pharmaceutical or biotechnology industry</li><li>
Must have applied experience in quality assurance auditing and applicable regulations</li><li>
Prior experience in regulatory inspections preferred</li><li>
Ability to establish collaborative working relationships with internal and external stakeholders</li><li>
Self-motivated and able to effectively prioritize and manage multiple projects</li><li>
Excellent time and project management skills Effective written and verbal communication skills with the ability to communicate clearly and concisely</li><li>
Ability to take ownership of specific projects, and to effectively lead and work with team members on projects as required</li><li>
Ability to travel (~25%) domestically and internationally</li></ul><p></p><p><br>
Concerned that you don&rsquo;t check off every box in the requirements listed above? Please apply anyway! At Agios, we value each other&rsquo;s differences and recognize that teams thrive when everyone brings their unique experiences to the table. We are dedicated to building an inclusive, diverse, equitable, and accessible environment where all employees can bring their whole selves to work. If you&rsquo;re excited about this role but your previous experience doesn&rsquo;t align perfectly with the job description, we still encourage you to apply. You may be just the right candidate for this role or another opening!</p><p></p><p><b><br>
Work Location:</b></p><p><b>
Location Agnostic: </b>Work location for this role is based on employee's individual preference. This role has the ability to be either remote in the US or hybrid in our Cambridge Headquarters. Hybrid schedules vary but are generally less than 3 days per week onsite and hybrid employees are expected to live within commutable distance to our Cambridge Headquarters. Remote employees work entirely from home except for attending Company sponsored events/ meetings. For employees who choose to work remotely, travel may be required for certain company events commensurate to the above job description..</p><p></p><p><b><br>
What we will give you:</b></p><ul><li><b><i>
Deliberate Development. </i></b>Your professional growth as one of our top priorities.</li><li><b><i>
Flexibility. </i></b>We&rsquo;re all about individual needs. We embrace different perspectives, work styles, health and wellness approaches, care of families and productivity. When you&rsquo;re at your best, we&rsquo;re at our best.</li><li><b><i>
Premium benefits package.</i></b> We invest in the health, wellbeing, and security of our people with a premium benefits package that is well-rounded and flexible to help meet the varied personal and professional needs of every member of our team. For more detail on the benefits we offer at Agios, visit the <b><i>Inside Agios</i></b> section of our website.</li><li><b><i>
Competitive and equitable performance-based compensation. </i></b>This includes base salary and both short- and long-term incentives that are connected to our business strategy and vary based on individual and company performance.<ul><li>
The current base salary range for this position is expected to be between $131,035 and $196,553 annualized; final salary will be determined based on various factors including, but not limited to, years of relevant experience, job knowledge, skills and proficiency, degree/education, and internal comparators.</li></ul></li><li><b><i>
Psychological safety. </i></b>We support an environment of fearlessness. We want you to share your ideas, speak candidly and take data-informed risks to help push the boundaries.</li><li><b><i>
Commitment to diversity. </i></b>We strive to foster a welcoming workplace where everyone can thrive. We&rsquo;re continuously looking to improve the inclusivity of our workforce.</li><li><b><i>
Commitment to community. </i></b>We&rsquo;re an active participant in the communities that surround us &ndash; the communities where we live, and the community of people and their loved ones in need of better treatment options for conditions that are often overlooked.</li></ul><p></p><p><b><i><br>
Interested in learning more about what makes our culture unique? Visit the </i></b><b><i>Inside Agios</i></b><b><i> section of our website.</i></b></p></div></div><p></p>

Senior Manager, GCP & GVP, QA

St. Vincent's Catholic Medical Center/ USFHP

<p><b>JOB SUMMARY </b></p><p>Reports to Team Lead, Clinical Quality and Record Review. Works independently and with other departments and/or vendors to ensure clinical potential quality issues are tracked, investigated and resolved in accordance with TRICARE and Plan requirements. Primarily responsible for conducting post-service in-depth clinical reviews (all care settings) in accordance with accepted standards of care. The overall goal is to improve clinical service delivery.</p><p><b>RESPONSIBILITIES</b></p><p><i>Clinical Review</i></p><ul><li>Utilizes clinical expertise to conduct clinical case retrospective reviews to determine deviation from standard of care or gaps in care and presence of mandatory data elements. Document progress of investigation and findings in internal databases and/or Excel spreadsheets.</li><li>Conduct clinical literature reviews and summarize findings.</li><li>Contact providers/facilities, as applicable, to obtain information and/or medical records needed to conduct a comprehensive clinical review of cases and final determinations.</li><li>Conduct chart reviews and audits both electronic and at medical facilities and providers&rsquo; offices. Abstract data relevant to review target.</li><li>Write succinct and targeted investigative summaries. Write quality review determination letters.</li><li>Develop and manage collaborative relationships with internal/external stakeholders and vendor staff.</li><li>Maintain confidentiality of all medical records, correspondence and related documents.</li><li>Effectively meets strict deadlines.</li><li>Aware of the potential for fraud and waste and how to report suspected fraudulent activity.</li></ul><p><i>Data Analysis and Reporting</i></p><ul><li>Participate in collection and analysis of data for clinical CDRLs reports (i.e., monthly quality issue report, AHRQ PSI report, annual clinical quality management program report).</li><li>Participate in collection, analysis and presentation of data for Peer Review, Credentials Review and Quality Committees.</li><li>Evaluate data for trends.</li></ul><p><i>Continuous Quality Improvement</i></p><ul><li>Participate in continuous quality improvement activities/root cause analysis to resolve identified quality issues and ensure forward movement in beneficiary service delivery.</li><li>Cross-train and perform other duties as assigned or required within the Quality Department. Attends meetings to achieve departmental/organizational goals and objectives.</li></ul><p><i>EXPERIENCE</i></p><ul><li>Five years of healthcare quality management experience.</li><li>Five years clinical nursing experience.</li><li>Quality assurance/improvement experience in a managed health plan, integrated health care system, or health care accreditation or regulatory agency.</li></ul><p><i>Skills/Competencies</i></p><ul><li>Ability to read, abstract and analyze medical records as well as other clinical data.</li><li>Analytical mindset with excellent organizational and problem-solving skills.</li><li>Ability to work both independently and as a team member.</li><li>Strong project management skills.</li><li>Intermediate statistical analysis expertise including interpretation of data.</li><li>Communications: Effective verbal and written communication skills. Able to work collaboratively with different teams and different team members. Ability to work both independently and as a team member.</li><li>Manages assigned caseload in accordance with established performance metrics.</li><li>Excellent customer service skills.</li><li>Understanding of medical terminology, anatomy, physiology and concepts of disease and health. Fundamental knowledge of ICD-10, CPT and HCPCS coding.</li><li>Understanding of Medicare, Medicaid and/or TRICARE.</li><li>Proficient in Microsoft Office, including but not limited to Excel, Outlook, PowerPoint and Word. Experience in Access and Visio a plus. Ability and inclination to adopt technology to maximize efficiency.</li><li>Decision making: Identification of clinical quality issues as evidenced by deviation from accepted standard of practice or gap in care. Ability to recommend corrective actions and/or sanctions.</li></ul><p><b>Education/Certifications/License</b></p><ul><li>Current and unrestricted state RN or LPN/LVN license required (CT, NJ, NY, PA)</li><li>BA, BS, or BSN preferred</li></ul><p><b>SALARY RANGE: LPN/LVN $80,000 &ndash; $85,000.00 RN $107,000.00 - $115,000.00</b></p><p><b>Benefits Statement</b></p><p>SVCMC, Inc. provides a robust benefits package that includes medical coverage through UnitedHealthcare/Oxford with no deductible for in-network services. Employees also receive vision coverage through UnitedHealthcare Vision and dental benefits through MetLife. Basic life and disability insurance are automatically provided at no cost. All employees are eligible for commuter benefits, tuition reimbursement, and a 401(k)retirement plan with an immediate employer match that is fully vested from day one. SVCMC also offers a generous time off package, which includes vacation, 10 paid holidays, and 3 personal days. Additionally, employees have access to a comprehensive Employee Assistance Program and exclusive discounts through Working Advantage.</p><p><i><b>SVCMC IS AN EQUAL OPPORTUNITY EMPLOYER - ALL QUALIFIED APPLICANTS WILL RECEIVE CONSIDERATION FOR EMPLOYMENT WITHOUT REGARD TO VETERAN STATUS, DISABILITY, OR OTHER CHARACTERISTICS PROTECTED BY LAW.</b></i></p><p>Pay: $80,000.00 - $115,000.00 per year</p><p>Benefits:</p><ul><li>401(k)</li><li>Dental insurance</li><li>Disability insurance</li><li>Employee assistance program</li><li>Health insurance</li><li>Paid time off</li><li>Referral program</li><li>Tuition reimbursement</li><li>Vision insurance</li></ul><p>Work Location: Hybrid remote in New York, NY 10018</p>

Clinical Quality Nurse Abstractor

University of Nebraska Medical Center

<div><div><h2 class="jobSectionHeader"><b>Requisition Details</b></h2>
<div><div><div>GENERAL REQUISITION INFORMATION
</div><p></p><div><div><div><div><b>EEO Statement:</b></div>
<div>UNMC is an Equal Employment Opportunity Employer, including an equal opportunity employer of protected veterans and individuals with disabilities.</div>
</div><br>
<div><div><b>Location</b></div> <div>Omaha, NE</div>
</div><br>
<div><div><b>Requisition Number:</b></div> <div>Staff_14605</div>
</div><br>
<div><div><b>Department</b></div> <div>Eppley Inst Research 50000686</div>
</div><br>
<div><div><b>Business Unit</b></div> <div>Eppley Institute</div>
</div><br>
<div><div><b>Reg-Temp</b></div> <div>Full-Time Regular</div>
</div><br>
<div><div><b>Work Schedule</b></div> <div>Monday - Friday, 8:00AM - 4:30PM or TBD</div>
</div><br>
<div><div><b>Remote/Telecommuting</b></div> <div>Hybrid (part-time working on site, part-time working off-site)</div>
</div><br>
<div><div><b>Position Summary</b></div>
<div>The Clinical Research Quality Management Administrator reports to, and is directly responsible to, Associate Director for Administration (ADA) for all matters pertaining to the systematic oversight, monitoring, and improvement of clinical trials activities.<br>
This role ensures that all oncology trials-including investigator-initiated (IIT) industry-sponsored, and national cooperative group studies-are conducted in adherence to National Cancer Institute (NCI),<br>
Designs and maintains monitoring plans to endure all clinical teams are prepared for internal and external inspections<br>
Supports and coordinates the Data Safety and Monitoring Committees (DSMC), following the FPBCC Data Safety and Monitoring Plan (DSMP), Protocol Review and Monitoring Systems (PRMS)<br>
</div>
</div><br>
<div><div><b>Position Details</b></div>
<div><b>Additional Information</b></div>
</div><br>
<div><div><b>Posting Category</b></div> <div>Operations</div>
</div><br>
<div><div><b>Working Title</b></div> <div>Clinical Research Quality Management Administrator</div>
</div><br>
<div><div><b>Job Title</b></div> <div>Health Care Specialist</div>
</div><br>
<div><div><b>Salary Grade </b></div><div>HC00H</div>
</div><br>
<div><div><b>Appointment Type</b></div> <div>B1 - REG MGR PROF SALARY</div>
</div><br>
<div><div><b>Salary Range</b></div> <div>$104,200 - $171,900/annual HC28S</div>
</div><br>
<div><div><b>Job Requisition Begin Date</b></div> <div>03/26/2026</div>
</div><br>
<div><div><b>Application Review Date</b></div> <div>04/01/2026</div>
</div><br>
<div><div><b>Review Date Information:</b></div>
<div>Initial application review will begin on the date provided in the field above. Applications received prior to this review date will be considered. Applications received after the review date may be considered.</div>
</div><br>
</div></div></div><div><div>Required and Preferred Qualifications
</div><p></p><div><div><div><div><b>Required Education:</b></div> <div>Bachelor's degree</div>
</div><br>
<div><div><b>If any degree major/training is required, please specify the type. (NOTE: Concentration and minors are not equivalent to a major)</b></div>
<div>Healthcare related fields (e.g. Clinical Research, Health Administration, Public Health or Nursing)<br>
</div>
</div><br>
<div><div><b>Required Experience</b></div> <div>7 years</div>
</div><br>
<div><div><b>If any experience is required, please specify what kind of experience:</b></div>
<div>Clinical Research experience of which three years must include progressively responsible management/supervisory experience.</div>
</div><br>
<div><div><b>Required License</b></div> <div>No</div>
</div><br>
<div><div><b>If yes, what is the required licensure/certification?</b></div>
</div><br>
<div></div><div><div><b>Required Computer Applications:</b></div> <div>Microsoft Excel, Microsoft Word, Microsoft Outlook</div>
</div><br>
<div><div><b>Required Other Computer Applications:</b></div>
</div><br>
<div></div><div><div><b>Required Additional Knowledge, Skills and Abilities:</b></div>
<div>Exceptional communication skills for collaborating with Principal Investigators (PIs), sponsors and multidisciplinary teams.<br>
Prior experience in quality assurance, auditing or regulatory affairs within clinical trials environment.</div>
</div><br>
<div><div><b>Preferred Education:</b></div> <div>Master's degree</div>
</div><br>
<div><div><b>If any degree/training is preferred, please specify the type:</b></div>
<div>Healthcare related fields (e.g. Clinical Research, Health Administration, Public Health or Nursing</div>
</div><br>
<div><div><b>Preferred Experience:</b></div>
</div><br>
<div></div><div><div><b>Preferred License:</b></div> <div>Yes</div>
</div><br>
<div><div><b>If yes, what is the preferred licensure/certification?:</b></div>
<div>Nursing<br>
Current certification through SOCRA (CCRP) or ACRP (CCRC/CCRA)</div>
</div><br>
<div><div><b>Preferred Computer Applications:</b></div>
</div><br>
<div></div><div><div><b>Preferred Other Computer Applications:</b></div> <div>Oncore, EPIC</div>
</div><br>
<div><div><b>Preferred Additional Knowledge, Skills and Abilities:</b></div>
<div>Deep knowledge of FDA (21 CRF Part 11), ICH/GCP, and HIPPA Regulations<br>
Familiarity with NCI Data Safety and Monitoring Committee (DSMC) requirements.<br>
Exceptional communication skills for collaboration with PI&rsquo;s, sponsors, multidisciplinary teams.<br>
String analytical skills with the ability to synthesize complex data into actionable leadership reports.<br>
High Degree of professional independence.<br>
Excellent interpersonal and organizational skills.<br>
Excellent writing, editing, and proofreading skills.<br>
Ability to take initiative and demonstrate strong commitment to duties.<br>
Ability to think critically and to compile and analyze data.<br>
Ability to analyze problems, implement solutions and multi-task.<br>
Ability to work within a deadline-driven structure.<br>
Ability to demonstrate leadership in change management.<br>
Strong proficiency in MS Office (Word, Excel. Outlook, Power Point)<br>
Proficiency in Oncore<br>
Prior clinical research experience at an NCI-designated cancer center or other NIH-funded research center<br>
</div>
</div><br>
<div><div><b>Email to a Friend</b></div> <div>https://unmc.peopleadmin.com/postings/97062</div></div></div></div></div></div></div></div><p></p>

Clinical Research Quality Management Administrator

Blue Shield of California

<div>
 <strong>
  Job Description
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  <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.
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 <strong>
  Responsibilities
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  <br/>
 </strong>
 <strong>
  Your Work
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  <br/>
 </strong>
 <strong>
  In this role, you will:
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 </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
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  <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.
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 <strong>
  About The Team
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  <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.
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 <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!
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 <strong>
  Our Values:
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 </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:
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 <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.
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 <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.
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 <br/>
 Please click here for further physical requirement detail.
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 <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

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