The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric, full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health's Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups, hospitals, health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first.
What We Offer
Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art, flexible Health & Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options, including medical, dental and vision plans, for the employee and their dependents, Health Spending Account (HSA), Life Insurance and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave.
This position will report to the: Director, Quality Management
Percentage Travel Required/Frequency: 25%
FLSA Status: Exempt
Remote Worker: Yes
Responsibilities What You'll be Responsible For in this Role Your Contribution & Career Journey
The Clinical Operations Specialist works with the Medical Director and Chief Operations Officer to develop, co-manage and oversee a wide range of Utilization Management (UM) and Quality Improvement (QI) initiatives.
What We're Looking For
We are looking for someone to Assist in the development, coordination and co-management of new and existing clinical QI and UM projects. In addition this person will be responsible to monitor and analyze internal and external data trends and patterns that affect the quality of care and service delivery. The Clinical Operations Specialist will also need to collaborate and partner with hospitals and health plans to optimize quality of care and lower healthcare costs.
Qualifications Minimum Qualifications:
A current unrestricted California State Registered Nurse License is required
3+ years experience in a managed care environment, such as a Medical Group, Healthplan, or Acute Care Hospital;
Acute Care Hospital experience is required.
Knowledge of statistical methodology in order to conduct studies and prepare related reports; Able to develop, analyze, present, and maintain data as it pertains to position.
Able to handle complex and variable cognitive applications with numerous interruptions;
Must possess a working knowledge and proficiency in computer applications such as Microsoft Word, Excel and the Internet; able to learn new computer software as necessary;
Interpersonal skills necessary to communicate effectively with a variety of individuals while conducting oneself in a courteous and professional manner in person, by telephone and e-mail communications.
Must demonstrate the ability to read, write and communicate fluently in English.
Additional Required Qualifications
Conduct clinical record review to assure health plan and regulatory compliance.
Identify efficiencies and develop tools to assist in the UM process.
Provide oversight and management of health plan UM audits.
Provide oversight, management and development of reliable processes to assure timely and accurate submissions of Health Plan reporting requirements.
Develop necessary tools and systems to meet the requirements of the QI and UM Work Plans with the Medical Director, the QI Manager, and the COO.
Assist in the development and maintenance of policies and procedures to assure compliance with regulatory requirements.
Participate in the reporting of studies identified in the QI and UM Work Plans.
Assist Nurse Case Managers and other PMG staff to identify opportunities for improvement in communication and daily workflow as it relates to the UM and QI processes.
Attend Healthplan meetings as required.
Participate in PMG Clinical meetings as required.
Attend conferences and collaborative meetings with the Medical Director as part of the quality improvement management team as required.
Attend general staff meetings as required.
Adhere to PMG established standards, policies, and procedures.
Equal Employment Opportunity
We are an equal opportunity employer committed to fostering a culturally diverse organization. We strive for inclusiveness and a workplace where mutual respect is paramount. We encourage applications from a diverse pool of candidates, and all qualified applicants will receive consideration for employment without regard to race, color, ethnicity, religion, sex, age, national origin, disability, sexual orientation, gender identity and expression, or veteran status. We will provide reasonable accommodations to qualified individuals with disabilities, as need, to assist them in performing essential job functions.
Dignity Health Management Services Organization does not accept unsolicited agency resumes. Dignity Health Management Services Organization is not responsible for any fees related to unsolicited resumes.