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Quality Review Coordinator

Location Denver, Colorado Job Number 1073619 Date posted 05/24/2022
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Salary Range: $41.68/hour - $48.99/hour

Job Summary:

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. Researches and stays abreast of regulations and statutes to determine the impact of implementation of new regulations and statutes.  Communicates required changes, develops tools to assess compliance with meeting regulations  and works with existing workgroups to facilitate the required changes. Is 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 and supports the Practitioner Peer Review Oversight Committee. Coordinates and maintains clinical and service quality improvement activity summaries for Center for Medicare and Medicaid Services, NCQA and other regulatory oversight bodies.  Proficient in the platforms required to perform the functions of the position - Metrs, Safety Connect, Peer Review Module, MSOW and Health Connect (EPIC). Responsible for Survey Readiness  for NCQA HP Accreditation, Patient Center Medical Home, Ambulatory Surgery Centers, Sleep Lab, CMS Special Needs Program,  and CHP+ Programs.  In addition, partner with other support services for survey readiness for ACR, MQSA, CLIA, MOHS and other areas in the organization that will adopt regulatory standards without the formal accreditation/certification. Involved in provider site visits related to Quality of Care concerns and Facility Credentialing, monitors Corrective Action Plans, and works with Clinical Quality Oversight and leadership on communicating results. May be involved with supporting the Quality Oversite Committee subcommittees and other committee work as needed to ensure that KFHP-CO remains in good standing with regulatory bodies. Assist managers and SMEs in developing, revising policies and procedures to meet the regulatory requirements. In addition to ad hoc project/work that is needed by the organization.

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. Coordinates (with Quality Review Physicians) peer review activities associated with individual practitioners and affiliated organizational providers, as well as assuring confidentiality of peer review information, maintaining current and accurate data on file for all peer review activities.

  • 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.

Basic Qualifications:

  • Minimum three (3) years of experience in quality improvement in a managed care environment.

  • Minimum three (3) years of nursing experience in a clinical setting.


  • Bachelors degree in nursing required.Graduate of board approved RN program.
License, Certification, Registration
  • Registered Nurse License (Colorado)
Additional Requirements:

  • 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 verbal, written, interpersonal and communication skills.
  • Ability to interface effectively with clinicians.
  • Proficient computer skills and knowledge of Word, Access and Excel, and Visio.
  • Experience with data base management and statistical process control (control charting).
Preferred Qualifications:

  • CPQH preferred.
  • Familiarity of requirements for Local, State/Federal agencies, nationally recognized accrediting bodies (NCQA, TJC, AAAHC, etc.) and Quality Improvement Organizations.
  • Experience with Surveys.
Primary Location: Colorado,Denver,Regional Office - Colorado Scheduled Weekly Hours: 40 Shift: Day Workdays: Mon, Tue, Wed, Thu, Fri Working Hours Start: 08:00 AM Working Hours End: 05:00 PM Job Schedule: Full-time Job Type: Standard Employee Status: Regular Employee Group/Union Affiliation: NUE-CO-02|NUE|Non Union Employee Job Level: Individual Contributor Department: Colorado Regional Offices - Legal - 1608 Pay Range (Colorado Only): $41.68/hour - $48.99/hour Travel: Yes, 5 % 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.