Would you like to be part of an organization that is committed to delivering the highest quality of medical care to our patients? Do you have a passion for using your nursing skills and leadership abilities in a state-of-the-art clinical environment? Then please consider applying for this full-time leadership role. We would be happy to hear from you!
Cedars Sinai Medical Care Foundation is a Medical Group that has 63 practice medical offices located throughout Los Angeles and growing. There are 636 health care providers, specializing in Qualified Audiologist, Obstetrics/Gynecology, Rheumatology, Internal Medicine, Nephrology, Hematology/Oncology, Endocrinology, General Surgery, Ophthalmology, Hospitalist and more. Medical taxonomies which are covered include Hospice and Palliative Medicine, Otolaryngology/Facial Plastic Surgery, Registered Nurse, Gynecology, Vascular & Interventional Radiology, Surgery, Clinical, Nuclear Radiology, Psychiatry, Neurology and many more.
The Manager, MN Quality & Patient Safety is responsible for providing leadership by managing, developing, and implementing systems and processes for the following programs throughout the Cedars-Sinai Medical Care Foundation (CSMCF) and its Affiliates: patient complaints and grievances (also known as Voice of the Customer), health plan site audits, peer review, occurrence reporting, and quality case reviews. The Manager participates in the continuous readiness program for health plan audits and contributes to the execution of the CSMCF Quality Plan. Collaborates with physician and administrative leaders, and Quality department staff to proactively develop quality and safety indicators derived from grievance, occurrence reporting, peer review, and quality case review data.
Summary of Essential Duties:
Participates in and oversees staff supporting patient grievances, occurrences, risk reports, quality case reviews, and credentialing. Interfaces with CSMCF and Affiliate medical leadership responsible for triaging issues through a quality management review process.
Manages and participates in focus quality case reviews to identify root cause of care and system gaps. Utilize expert clinical knowledge and experience to collaborate with the QI Coordinators, Chief Medical Officer, and Medical Directors during quality case reviews.
Responds to adverse events and patient grievances as needed. Track, trend and monitor status of cases to ensure accurate and timely resolution of cases. Conducts thorough investigations, develops plans of corrective action plans as needed, and monitors cases and trends to ensure continuous quality and safety improvement.
Meets all health plan and regulatory requirements related to delegation, certification and licensing survey activities. Develops and is accountable for submission of the yearly quality management plan and other reports to health plans. Adheres to the organization's Code of Ethics and Corporate Compliance Program. Complies with all relevant policies, procedures, guidelines, and all other regulatory and accreditation standards.
Assists in the development, review and revision of clinical policies and procedures, group and Foundation bylaws, rules and regulations, and is familiar with the professional services agreement (PSA) language related to medical staff requirements related to clinical quality improvement.
In conjunction with the Director, is responsible for the development, evaluation, implementation, and monitoring of QM programs and procedures; and for the integration of the QM Program across CSMCF and its Affiliates.
Assumes leadership role in CSMCF quality management audits and surveys. Ensures an infrastructure for continual readiness for external surveys. Responds to and coordinates communication and/or visits from Health Plans and other agencies.
Manages the Physician Peer Review Committee and Patient Safety Committee-related projects; Supports CSMCF's Safety program by providing leadership and acting as a resource to Operational and Risk Management leadership. Is a resource for CSMCF Peer Review activities.
Build relationships and collaborate with key internal and external stakeholders to ensure timely completion of QM program-related tasks.
Subject matter expert on NCQA and other health plan accreditation, legal and regulatory standards for the medical network groups and affiliated physician practices.
Identify opportunities for sustained performance improvement based on quality strategic goals, organizational performance and evaluation of best practice opportunities.
Directly hires, supervises, manages, and provides leadership to clinical (RN) and non-clinical staff supporting grievances and complaints, peer review process, quality case reviews, health plan quality audits and/or health system standards.
Administratively supports Quality Management staff services by selecting, hiring, orienting and training, coaching and developing employees.
Facilitates organization-wide new employee orientation/training by representing the Quality Department in applicable areas.
Master's degree preferred
Current, unrestricted California RN license required
Five years of progressive and successful healthcare management and leadership.
Two or more years HMO/Managed Care experience is preferred.
Knowledge of health care regulations, accreditation, and licensing requirements preferred.
Two years prior training and experience utilizing process improvement principals based on Lean and Six Sigma methodology for streamlining and refining specific work process, preferred.
Working Title: Manager(Registered Nurse) - MN Quality & Patient Safety
Providing healthcare for more than 100 years, Cedars-Sinai has evolved into one of the most dynamic and highly renowned medical centers in the world. Along with caring for patients, Cedars-Sinai is a hub for biomedical research and a training center for future physicians and other healthcare professionals. This attracts exceptional talent to Cedars-Sinai, including world-renowned physician-scientists who seek a place where they can both conduct research and see patients--the ideal formula for discovery and its translation into cures. Our patients benefit from access to doctors at the top of their fields, and our researchers have an ideal community in which to study the impact of healthcare challenges, and reflect that knowledge in their research. The greater Los Angeles area in which Cedars-Sinai resides possesses unparalleled cultural and ethnic diversity which offers outstanding opportunities for translational and clinical research and a dynamic environment for medical education.Although community based, Cedars-Sinai is a major t...eaching hospital affiliated with the David Geffen School of Medicine at the University of California, Los Angeles (UCLA). Cedars-Sinai has highly competitive graduate medical education programs in more than 50 specialty and subspecialty areas, a graduate program in biomedical sciences and translational medicine, a clinical scholars program directed towards junior physicians with aspirations to become clinical scientists, and post graduate training opportunities.There are more than 250 full-time faculty members at Cedars-Sinai. The voluntary medical staff, comprised of more than 2,200 specialty board-certified or board-qualified physicians, represent all of the specialties and subspecialties and collaborate with full-time medical staff in the teaching responsibilities of the graduate medical education programs.