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Kaiser Permanente Careers

Quality Assurance, UR & Case Management

Passion + Vision + Integrity = Excellence

Ensure consistency and the highest ethical standards across our entire organization. Our quality assurance team drives ongoing improvement by fostering an environment of support, providing technical and specialized consultative services, and inspiring ongoing excellence.

Quality Review Coordinator

Location: Denver, CO Additional Locations:
Job Number: 840241 Date posted: 11/15/2019
As an individual contributor, the position of Quality Review Coordinator helps to ensure patient safety, quality and regulatory compliance. This is accomplished through performing  ongoing assessments against Accreditation, Regulatory and Licensure requirements and responsible for ensuring gaps are closed and improvement sustained; assessment and monitoring of quality of care and service related activities including but not limited to peer review; site assessments for all KFHP-CO ambulatory care and affiliated sites as needed; investigation of quality of care complaints internally and from external sources, i.e. the Quality Improvement Organization (QIO) and other Federal/State monitoring agencies. Coordinates and maintains activities related to ongoing practitioner performance review. Coordinates and maintains clinical and service quality improvement activity summaries for Center for Medicare and Medicaid Services, NCQA and other regulatory oversight bodies. Supports committee work as needed and other activities required to ensure that KFHP-CO remains in good standing with regulatory bodies.

Essential Responsibilities:
  • This position knows and complies with all Kaiser Permanente quality, safety, and emergency policies and procedures. Demonstrates quality and safety in every day work. Reports safety hazards, accidents and incidents, and unsafe working conditions promptly.
  • Maintains and supports review activities of the CMS, Colorado Foundation for Medical Care and State sponsored programs.
  • Responsible  for obtaining the appropriate documentation and updating the appropriate data repository for credentialing and recredentialing of  affiliated providers(i.e., Facilities , hospitals, nursing homes and free standing ambulatory surgical centers); provides reports to appropriate staff/committee(s).
  • Collaborates with Contracting and the appropriate staff responsible for ensuring that organizational providers are credentialed and recredentialed according to meeting NCQA standards.
  • Develops and maintains policies and procedures on all review activities.
  • Performs all Quality of Care reviews in the appropriate time frame and follows a consistent process.
  • Consults and provides expertise in NCQA and other regulatory oversight. Responsible for survey readiness including reporting and keeping current on regulatory requirements.  Develops site visit criteria and performs site visits as appropriate. Facilitate the development of corrective action plans as necessary and interacts with all applicable departments to assure site visit compliance, i.e., infection control, facilities, laboratory and imaging

  • This role is located in the Denver area and will be required to be in the area 4-5 days per week. Relocation is not included. This is not a telecommuter role. 
    Basic Qualifications:
  • Minimum three (3) years of experience in quality improvement and peer review systems.
  • Education
  • Bachelor's degree in nursing required.
  • Graduate of board approved RN program; with current Colorado licensure.
  • License, Certification, Registration
  • N/A

  • Additional Requirements:
  • Familiarity of requirements for Local, State/Federal agencies, nationally recognized accrediting bodies (NCQA, JCAHO, AAAHC, etc.) and Quality Improvement Organizations.
  • Knowledge of study design principals (planning, measurement selection, analysis and methodology), including intervention strategies and methods and approaches for barrier analysis.
  • Ability to analyze and problem solve.
  • Possesses effective interpersonal and communication skills.
  • Ability to interface effectively with clinicians.
  • Proficient computer skills and knowledge of Word, Access and Excel.
  • Experience with data base management and statistical process control (control charting).

  • Preferred Qualifications:
  • Three (3) years of experience in quality improvement and peer review systems in a managed care environment preferred.
  • Main location is Regional; however, the role supports the region so travel to other MOBs is expected as needed.
    Primary Location: Colorado,Denver,Regional Office - Colorado 10350 E. Dakota Ave. Scheduled Weekly Hours: 40 Shift: Day Workdays: Mon - Fri Working Hours Start: 8:00 AM Working Hours End: 5:00 PM Job Schedule: Full-time Job Type: Standard Employee Status: Regular Employee Group/Union Affiliation: Salaried, Non-Union, Exempt Job Level: Individual Contributor Job Category: QA / UR / Case Management Department: Accreditation, Licensing and Regulatory Travel: Yes, 20 % of the Time Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.

    External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances.

    About QA, Ur & Case Management Careers

    Careers In QA, Ur & Case Management

    As an organization, we are committed to delivering the same exemplary care no matter who you are, where you are, or what your needs. But how are those standards defined, measured, and assessed? That's where our quality assurance team comes in. Implementing the action plans and initiatives that will drive successful practices, you'll work across the organization to foster the necessary education, communication, and innovation that will enable us to operate as one KP — with our mission and goals in complete alignment.

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