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  • SLED Contract Specialist

    Vertosoft

    Quality improvement specialist job in Leesburg, VA

    Job Title SLED Contract Specialist Department / Team Legal and Contracts Team Reporting Structure Reports to: Government Contracts Program Manager Supervises: None (Individual Contributor role) Location & Work Model Leesburg, VA - Hybrid FLSA Status Exempt Position Summary Vertosoft is seeking a State, Local, and Education (SLED) Contract Specialist to join our Legal & Contracts team. This role is responsible for managing and supporting the full lifecycle of SLED contracts, with a focus on maintaining compliance and operational excellence across Vertosoft's diverse portfolio of cooperative agreements. The position offers the opportunity to work closely with suppliers, procurement officers, and internal teams to ensure alignment with contract terms, drive efficiency, and contribute to Vertosoft's continued growth in the public sector. Key Responsibilities • Contract Lifecycle Management: Administer day-to-day activities related to SLED contract management, including onboarding suppliers, amendments, renewals, and closeouts. • NASPO and Cooperative Contract Oversight: Manage and support NASPO ValuePoint and other cooperative agreements, ensuring proper reporting, compliance, and supplier engagement. • Contract Execution: Prepare, review, and process contract documents and modifications in coordination with internal stakeholders and suppliers. • Compliance & Reporting: Maintain accurate records and ensure timely submission of required documentation to contract authorities. • Audit Preparation: Support internal and external audits by ensuring all SLED contract files are organized, current, and compliant with state and cooperative procurement rules. • Stakeholder Collaboration: Serve as a liaison between Vertosoft, government procurement offices, and supplier partners to address contract-related inquiries and ensure adherence to contractual obligations. • Process Improvement: Identify and implement enhancements to contract workflows, templates, and systems for greater efficiency and accuracy. • Market Awareness: Stay informed of changes in SLED procurement policies, cooperative contract updates, and industry trends to support strategic decision-making. • Other Duties: Perform additional tasks as assigned, including supporting other departments and participating in specialized projects. Required Qualifications • Education: Bachelor's degree in Business Administration, Public Administration, or related field required. • Experience: o Minimum 2 years of experience in contract administration; 3+ years preferred. o Direct experience with SLED or cooperative contracts (NASPO, Sourcewell, OMNIA, TIPS, etc.) preferred. • Skills: o Proven ability to interpret and manage complex contract requirements. o Strong analytical, organizational, and communication skills. o Excellent attention to detail and ability to manage multiple priorities. o Team-oriented with a proactive, solutions-driven approach. • Tools: o Proficiency with Microsoft Office. o Familiarity with contract management or CRM tools (Salesforce experience preferred). Key Competencies • Detail-oriented and compliance-driven. • Strong problem-solving and organizational skills. • Collaborative and adaptable in a dynamic environment. Compensation & Benefits • Competitive base salary with bonus potential. • Comprehensive benefits package including health, dental, vision, and pet insurance. • 401(k) with company match. • Paid Time Off and all Federal holidays off. • Hybrid work schedule (Leesburg, VA). • Career development and growth opportunities. About Vertosoft Vertosoft is a small business dedicated to accelerating the adoption of innovative and emerging technology in government. We combine agility, flexibility, and experience to streamline the acquisition lifecycle and deliver cutting-edge solutions to public sector agencies. Our team is known for its professionalism, ethics, and deep understanding of the government procurement landscape. Vertosoft is an Equal Employment Opportunity Employer. All qualified applicants will be considered without regard to race, color, religion, sex, age, national origin, sexual orientation, gender identity, marital status, disability, veteran status, or any other characteristic protected by law.
    $60k-102k yearly est. 4d ago
  • Senior AEC Hiring Specialist

    Designforce

    Quality improvement specialist job in Washington, DC

    Senior AEC Hiring Strategist We're looking for a Senior Consultant to join our Workforce Strategy team in Washington, DC. In this role, you'll partner with executives across engineering and architecture firms to help them attract, hire, and retain top talent. You'll oversee and execute high-level strategic searches, advise clients on employee engagement and development practices, and build lasting relationships with career professionals across the AEC industry. This role is ideal for someone who loves connecting people with purpose, understands the nuances of talent in a technical industry, and wants to make a tangible impact on how firms grow and lead their teams. Why DesignForce? At DesignForce, we're a hardworking, passionate, and collaborative team united by one mission - to elevate the employee experience in the AEC industry. As a proud Certified B Corporation, we're guided by principles of social responsibility, ethics, and impact. We balance purpose and fun, with a culture that celebrates connection and creativity through happy hours, team bonding events ( sip-and-paint nights, bowling, paintball, escape rooms, axe throwing and more), and biweekly catered lunches. Our biweekly internal trainings reflect our deep commitment to innovation and continuous learning, we're always looking for ways to elevate our people and our work. We bring high energy and fresh ideas to everything we do, working in a flexible hybrid environment out of our vibrant, modern office in Dupont Circle. Core Responsibilities Include: Develop and foster long-term relationships with professionals in the design and building industries, assisting them with their career development. Provide personalized career coaching sessions for professionals within the Architecture, Interiors, Engineering, Development and Construction fields. Assist with the development and execution of workforce strategy initiatives, including 360-performance reviews, strategic planning, benefits benchmarking, compensation analysis, and employee engagement surveys. Partner strategically with organizational leaders and hiring managers to proactively assess talent needs, providing expert guidance to shape workforce planning and ensure alignment with both immediate and long-term business objectives. Source talent and continue to build and enhance an active National network through various channels like LinkedIn, social media, and industry networking events. Aid in the development and facilitation of high impact learning and development workshops. Research and write industry-specific blog articles to promote DesignForce and personal brand. Preferred Qualifications Include: Hold a BA or BS in Communications, Human Resources, Psychology, Architecture, Interior Design, Civil Engineering, or a related field. 4+ professional years of experience, with a strong preference of 2+ years being focused in talent acquisition, recruiting, human resources, career coaching, design, engineering consulting, or a related field. Display exemplary communication capabilities, effectively communicating verbally and through writing. Demonstrate strong ownership of your workload by proactively managing client and internal team relationships, independently establishing realistic deadlines, and consistently delivering results that meet or exceed the highest standards of excellence. Be able to pivot quickly and adapt to change in a fast-paced, high-energy environment. Love food. Seriously. We like to eat. (Specific knowledge about the DC food scene is a plus but not a requirement). Additional Information - We Take Care of Our People by Providing the Following Benefits: Generous Paid Time Off (PTO) & Paid Holidays Paid Voting & Wellness Leave Annual Professional Development Budget Paid Parental Leave On-Site Gym Membership Comprehensive Medical, Dental, and Vision Coverage 401(k) with Matching Quarterly Team Volunteering Outings Professional Development Support Bi-Weekly Catered Team Lunch Equal Opportunity Employer At DesignForce, we don't just accept difference - we celebrate, support, and thrive because of it. DesignForce is a proud equal-opportunity employer. Employment at DesignForce is based solely on a person's merit and qualifications directly related to professional competence. DesignForce does not discriminate against any employee or applicant because of race, creed, color, religion, gender, sexual orientation, gender identity/expression, national origin, disability, age, genetic information, veteran status, marital status, pregnancy, or related condition (including breastfeeding), or any other basis protected by law.
    $80k-119k yearly est. 23h ago
  • Quality Improvement Project Specialist, Remote

    Aledade 4.1company rating

    Remote quality improvement specialist job

    The Quality Improvement Project Specialist plays a key role in supporting quality initiatives by identifying, advancing, and communicating key objectives while utilizing QI best practices and project management tools to track progress and ensure successful execution across internal and external workstreams. Reporting directly to the VP of Clinical Quality, this role requires expertise in value-based care with a particular focus on quality initiatives. The ideal candidate will act as a right hand to the VP, managing multiple deliverables and collaborating closely with both internal teams and external partners. Strong communication and stakeholder engagement skills are essential, as this position offers the opportunity to work in partnership with senior leadership and contribute to driving organizational quality goals.Primary Duties: Aggregate and analyze data from multiple sources, to generate insights, presenting findings through reports and dashboards that highlight the potential impacts on key performance indicators and overall business objectives. Define the optimal approach for each project including defining roles, stakeholder involvement, risk assessment, resource constraints, dependencies and expected outcomes, reviewing and approving processes, anticipating milestone dates, and adjusting throughout the course of the project to ensure alignment with quality team objectives. . Monitor project progress, assess team capacity, and adjust as needed to maintain execution velocity, while managing multiple priorities. Organize and lead cross-functional, quality-related project meetings. Including agenda development, scheduling, presentation preparation, documentation of notes and tracking follow-up actions. Develop clear and compelling presentations and reports to effectively communicate quality improvement strategies and outcomes to diverse audiences. Perform administrative tasks as directed by quality team members to support project execution and team operations Minimum Qualifications: Bachelor's degree required Proven ability to manage projects with excellence: successfully toward completion, coordinating and collaborating across multiple projects and teams, with foresight and timely communication Advanced command of Excel, Google Sheets, and related data manipulation tools Strong skills with presentation tools such as PowerPoint and Google Slides 5+ years of work experience (preferred) Have experience and thrive in a fast-paced environment Willingness to travel as needed to Aledade's headquarters or markets 10-15% of the time Preferred Qualifications: PMP certification preferred; Quality Improvement certification a plus (Lean 6 Sigma, IHI Quality Coach or Improvement Advisor, etc.) Understanding and having experience with Tableau, Miro, Jira, Monday.com Experience in value-based care Physical Requirements: Sitting for prolonged periods of time. Extensive use of computers and keyboard. Occasional walking and lifting may be required. Who We Are:Aledade, a public benefit corporation, exists to empower the most transformational part of our health care landscape - independent primary care. We were founded in 2014, and since then, we've become the largest network of independent primary care in the country - helping practices, health centers and clinics deliver better care to their patients and thrive in value-based care. Additionally, by creating value-based contracts across a wide variety of health plans, we aim to flip the script on the traditional fee-for-service model. Our work strengthens continuity of care, aligns incentives and ensures primary care physicians are paid for what they do best - keeping patients healthy. If you want to help create a health care system that is good for patients, good for practices and good for society - and if you're eager to join a collaborative, inclusive and remote-first culture - you've come to the right place. What Does This Mean for You?At Aledade, you will be part of a creative culture that is driven by a passion for tackling complex issues with respect, open-mindedness and a desire to learn. You will collaborate with team members who bring a wide range of experiences, interests, backgrounds, beliefs and achievements to their work - and who are all united by a shared passion for public health and a commitment to the Aledade mission. In addition to time off to support work-life balance and enjoyment, we offer the following comprehensive benefits package designed for the overall well-being of our team members: Flexible work schedules and the ability to work remotely are available for many roles Health, dental and vision insurance paid up to 80% for employees, dependents and domestic partners Robust time-off plan (21 days of PTO in your first year) Two paid volunteer days and 11 paid holidays12 weeks paid parental leave for all new parents Six weeks paid sabbatical after six years of service Educational Assistant Program and Clinical Employee Reimbursement Program 401(k) with up to 4% match Stock options And much more! At Aledade, we don't just accept differences, we celebrate them! We strive to attract, develop and retain highly qualified individuals representing the diverse communities where we live and work. Aledade is committed to creating a diverse environment and is proud to be an equal opportunity employer. Employment policies and decisions at Aledade are based on merit, qualifications, performance and business needs. All qualified candidates will receive consideration for employment without regard to age, race, color, national origin, gender (including pregnancy, childbirth or medical conditions related to pregnancy or childbirth), gender identity or expression, religion, physical or mental disability, medical condition, legally protected genetic information, marital status, veteran status, or sexual orientation. Privacy Policy: By applying for this job, you agree to Aledade's Applicant Privacy Policy available at *************************************************
    $48k-67k yearly est. Auto-Apply 23d ago
  • Quality Improvement Specialist - Oncology Programs

    Sentara Healthcare 4.9company rating

    Remote quality improvement specialist job

    City/State Norfolk, VA Work Shift First (Days) The Quality Improvement Specialist for Oncology Programs works in collaboration with clinical leadership. This position plays a vital role in managing quality improvement and quality assurance activities for the designated program(s). Primary responsibilities include developing, implementing and coordinating activities to ensure compliance with NCQA accreditation requirements, and state and federal quality measures, initiatives and guidelines. Responsibilities also entail collaborating with assigned areas to develop, implement and measure quality improvement initiatives designed to improve patient care, patient safety and reduce costs. Quality improvement and assurance activities include but are not limited to; collecting and analyzing data, implementing, tracking and reporting on quality activities and interventions, developing and maintaining policies & procedures to ensure compliance to quality activities and standards, auditing and committee participation. All licenses must be maintained in area of specialty. May require local travel. Education Bachelor's degree in Health Administration or health-related field required Certification/Licensure No specific certification or licensure requirements Experience: Two years of experience working with (cumulatively) Medicaid Managed Care, CMS, NCQA Health Plan Standard Two years of work experience in quality improvement Keywords: Quality Improvement, healthcare, oncology, hospital, Talroo-Allied Health . Benefits: Caring For Your Family and Your Career • Medical, Dental, Vision plans• Adoption, Fertility and Surrogacy Reimbursement up to $10,000• Paid Time Off and Sick Leave• Paid Parental & Family Caregiver Leave • Emergency Backup Care• Long-Term, Short-Term Disability, and Critical Illness plans• Life Insurance• 401k/403B with Employer Match• Tuition Assistance - $5,250/year and discounted educational opportunities through Guild Education• Student Debt Pay Down - $10,000• Reimbursement for certifications and free access to complete CEUs and professional development• Pet Insurance • Legal Resources Plan• Colleagues may have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met Here at Sentara, we are committed to consistently enhancing our training, advancement tracks, work-life benefits, and more. Our goal is to make you feel more excited to be here every day! Sentara Norfolk General Hospital, located in Norfolk, VA, is a 525-bed tertiary care facility that is home to the only Level I Adult Trauma Center and burn trauma unit in Hampton Roads, and also serves as the primary teaching hospital for Eastern Virginia Medical School. In addition to the high-quality heart program at Sentara Heart Hospital, our facility is home to Nightingale Regional Air Ambulance and several other dedicated facilities and specialized services. As a recognized accredited Comprehensive Stroke Center, and Magnet hospital for nursing excellence, our hospital specializes in heart and vascular, neurosciences, neurosurgery, urology, oncology, spine care, advanced imaging, behavioral health, maternity, and women's health, including a state-of-the-art neonatal intensive care unit. Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves. In support of our mission “to improve health every day,” this is a tobacco-free environment. For positions that are available as remote work, Sentara Health employs associates in the following states: Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.
    $44k-62k yearly est. Auto-Apply 35d ago
  • Quality Improvement Specialist 2 - Full Time - Remote

    University of Miami 4.3company rating

    Remote quality improvement specialist job

    Current Employees: If you are a current Staff, Faculty or Temporary employee at the University of Miami, please click here to log in to Workday to use the internal application process. To learn how to apply for a faculty or staff position using the Career worklet, please review this tip sheet. The Quality Improvement Specialist 2 leads and directs multiple complex projects with high levels of functional and clinical integration across the UHealth enterprise. The incumbent is responsible for medium to large scale project lifecycles from request, assessment, planning, execution, monitoring and optimization. This role is expected to leverage Project/Performance Improvement (PI) principles (e.g., Lean Six Sigma, PDSA, and Industrial Engineering) and Project Management (PM) principles and tools that will have a direct impact in healthcare quality, patient safety, clinical transformation, value based care, and/or clinical variations to successfully design, communicate, and strategically implement healthcare quality programs and initiatives that deliver on key organizational objectives. 1. Leads collaborative efforts by fostering a culture of shared accountability in a high performing work group. 2. Assembles and leverages project teams, assigning individual responsibilities, identifying appropriate resources needed and developing a roadmap and schedule to ensure timely completion of projects. 3. Analyzes clinical quality data, identifies opportunities, and develops and implements action plan for quality improvement initiatives. 4. Delivers solutions that are systematic, scalable, incorporate business process management, incorporate advanced technology solutions, and often impact organizational culture and clinical transformation. 5. Ensures adherence to quality and data governance standards. 6. Ensures recommended solutions meet the targeted business/clinical objectives, and a plan is in place to monitor sustainability of the recommendations. 7. Communicates from the top down and bottom up regarding the team responsibilities, target dates, project status, resource needs and provides general project communication as needed. 8. Fosters clear communication and synchronizes the activities of multiple projects and teams. 9. Creates and maintains proper documentation of project related tasks and timelines. 10. Presents recommendations and strategies to decision makers that are systematic, scalable, incorporate business process management, incorporate technology solutions, and often impact organizational culture and clinical transformation. 11. Collaborates with and mentors employees in Quality Improvement Specialist 1 positions. 12. Works closely with the Patient Safety & Quality leadership team. 13. Adheres to University and unit-level policies and procedures and safeguards University assets. This list of duties and responsibilities is not intended to be all-inclusive and may be expanded to include other duties or responsibilities as necessary. CORE QUALIFICATIONS Education: Bachelor's degree in relevant field Experience: Minimum 5 years of relevant experience Knowledge, Skills and Behaviors: * Ability to maintain effective interpersonal relationships * Ability to communicate effectively in both oral and written form * Skill in collecting, organizing and analyzing data * Proficiency in computer software (i.e., Microsoft Office) The University of Miami offers competitive salaries and a comprehensive benefits package including medical, dental, tuition remission and more. UHealth-University of Miami Health System, South Florida's only university-based health system, provides leading-edge patient care powered by the ground breaking research and medical education at the Miller School of Medicine. As an academic medical center, we are proud to serve South Florida, Latin America and the Caribbean. Our physicians represent more than 100 specialties and sub-specialties, and have more than one million patient encounters each year. Our tradition of excellence has earned worldwide recognition for outstanding teaching, research and patient care. We're the challenge you've been looking for. The University of Miami is an Equal Opportunity Employer - Females/Minorities/Protected Veterans/Individuals with Disabilities are encouraged to apply. Applicants and employees are protected from discrimination based on certain categories protected by Federal law. Click here for additional information. Job Status: Full time Employee Type: Staff Pay Grade: H12
    $44k-58k yearly est. Auto-Apply 3d ago
  • Manager, Market Quality Improvement - Must Reside in Georgia

    Caresource 4.9company rating

    Remote quality improvement specialist job

    The Manager, Market Quality Improvement manages the day-to-day prioritization of staff activities in collaboration with Director, Quality Improvement. The Manager will be responsible for developing quality documents in compliance with state and federal requirements and work with departments outside of quality to obtain information for reports. Essential Functions: Responsible for Corporate oversight of the HEDIS Medical Record Review Unit as needed for the assigned market Responsible for development and oversight of Quality Improvement (QI) Projects and Performance Improvement Projects related to HEDIS and pay for performance (P4P) requirements Ensures compliance with External Quality Review audits/studies, Performance Improvement Projects, and Quality Improvement Projects required by the state, NCQA, and other accreditation bodies Responsible for the review of QI issues regarding compliance with Federal, State, and Accreditation requirements Ensure all policies and procedures are aligned with Federal, State, and Accreditation requirements Responsible for the annual review, program description, program plan, and update of QI Department policies and procedures Provide education to internal and external customers on quality improvement functions Respond to questions that pertain to HEDIS and Quality Improvement from providers and internal staff members Foster relationships with all internal departments and represents CareSource to community-based and state programs Collaborate with business owners to establish, implement, and develop best practices for P4P quality directives Implement opportunities for process improvement that impact quality measurements in assigned market Monitor industry trends as it relates to healthcare and identify areas of opportunity for improvement Responsible for ensuring business owners successfully complete all deliverables related to performance improvement plans (PIPs) and quality improvement plans (QIPs) within defined timeframes Conducts analysis, including root cause analyses with support from identified business units and ensure data is presented and used efficiently to meet the quality goals Follows enterprise standards and procedures for all quality reporting and documentation and communicate areas of strengths as well as needs to the Quality Improvement Committee Perform all facets of quality management to include the development of detail work plans, setting deadlines, assigning responsibilities and monitoring/summarizing project progress Establish, monitor and review mechanisms to assess and document each business units level of compliance with each measure and coordinate corrective actions Attends and participates in market quality committees Guide and direct successful completion of daily tasks and projects Interview, select and train new team members Conduct performance management activities for direct reports, to include monthly one-on-one meetings, annual performance appraisals, and discipline as appropriate Perform any other job related instructions, as requested Education and Experience: Bachelor's Degree or equivalent years of relevant work experience is required Completion of an accredited Registered Nursing degree program or Bachelor's of Science in Nursing (BSN) is preferred Master's Degree in Nursing (MSN), Public Health, or healthcare related field is preferred A minimum of three (3) years of experience in a healthcare or managed care organization is required Previous management experience is required Medicaid and/or Medicare experience preferred Experience in quality metrics preferred Competencies, Knowledge and Skills: Intermediate proficiency in Microsoft Word, Excel and PowerPoint Solid leadership skills; able to effectively manage a high performing team, provide coaching and development Demonstrated ability to adjust and shift priorities, multi-task, work under pressure and meet deadlines Proven ability to recognize opportunity for improvement and lead change Data analysis and trending skills Effective communication skills Prior supervisory skills Ability to work independently & in a team environment Training/teaching skills Time management skills Critical listening and thinking skills Strategic management skills Decision making/problem solving skills Customer service oriented Licensure and Certification: Current, unrestricted Registered Nurse (RN) licensure in the state of practice is preferred Certified Professional in Healthcare Quality (CPHG) is preferred Working Conditions: General office environment; may be required to sit/stand for long periods of time Some in state travel required (approximately 20% of time) Compensation Range: $81,400.00 - $130,200.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package. Compensation Type (hourly/salary): Salary Organization Level Competencies Fostering a Collaborative Workplace Culture Cultivate Partnerships Develop Self and Others Drive Execution Influence Others Pursue Personal Excellence Understand the Business This is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.#LI-JM1
    $81.4k-130.2k yearly Auto-Apply 1d ago
  • Clinical Quality Improvement Specialist (RN)

    Vitas Healthcare 4.1company rating

    Quality improvement specialist job in Fairfax, VA

    JOB RESPONSIBILITIES Performs ongoing quality assessment through data collection and analysis as directed by VITAS Policies, Procedures, and Standards. Works with hospice program leadership to identify quality and performance trends and areas for improvement. Performs quality monitoring activities (tracking, trending, and analysis) including, but not limited to: Hospice Quality Reporting Program (HQRP): data collection and analysis of data associated with HQRP components, including but not limited to: Consumer Assessment of Healthcare Providers and Systems survey (CAHPS), claims-based measures, Hospice Item Set and any future measures. Care Compare: data collection, tracking, and benchmarking HQRP scores against competitors. CAHPS survey: Identify negative comments/responses and initiate service comments as appropriate. QAPI dashboard: drill down, analyze and report data. Service Comments: includes monitoring timely resolution, reassignment of pending service comments, communication of trends to program management, and ensure service comment log is current. Infection Control Reporting: data maintenance and analysis. Incident Reporting: data maintenance and analysis, submission of documents for incidents identified as serious adverse events, completion of 3500A for home medical equipment-related incidents. Root Cause Analysis (RCA): co-facilitate RCA meeting with program management, ensure required documents are completed, document meeting on appropriate templates, submission of documents to required email distribution group, monitor effectiveness of corrective action plan and report outcomes to program leadership. Revenue Analysis and Tracking: analyze and trend Unaccrued Revenue using report provided by Revenue Cycle Management and report findings to program management. Hospice Aide (HA) In-service hours: obtain training completion report and report compliance with regulation requirement to program management. Annual Update HIPAA/OSHA: Obtain training completion report for annual updates and report compliance to senior management. Physician satisfaction surveys (as required by the program): data collection, analysis, and reporting. Revocation and discharge monitoring (as required by the program): data collection, analysis, and reporting. Collect and analyze quality indicator data/key performance indicators and collaborate with the senior management team to identify priorities for improvement and develop initiatives. Performs Quality reporting updates monthly, quarterly, and annually, including but not limited to: Quality Update Report (QUR): prepare and submit monthly report to regional and senior management to communicate updates of Quality Assessment and Performance Improvement areas. QAPI IDG Committee Meeting (quarterly): prepare documents, co-facilitate meeting, capture minutes, submit documents, follow up on actions items from meeting. Annual Reports: complete QAPI Program Annual Evaluation, prepare Annual Program Operational Review for program management completion, and any state-specific requirements. -Facilitates Performance Improvement Projects including the coordination of performance improvement teams. -Maintains Documentation of Performance Improvement Initiatives (both hard copy and electronic). -Maintains any and all versions of the PI Plan Manual. -Identify program needs based on data analysis of the quality monitoring activities and recommend training to address these needs. -Report to senior management on compliance with required trainings including orientation and legally mandated in-services. Act as the program liaison to Central Support: Submission of quarterly QAPI IDG and annual report documents including policy recommendations via the Governing Body Report. Regarding quality initiatives: provides field perspective and participates in the development of company-wide materials. -Collaborates with the PCA for external audits and records requests. -Participate in pilot projects related to QAPI initiatives as requested. -For programs or regions with a Performance Improvement Specialist (PIS) Assistant: Oversight of the Performance Improvement Specialist (PIS) Assistant, including delegation of approved tasks and mentorship for delegated tasks as needed. Other duties as assigned. JOB REQUIREMENTS 1. Ability to work independently and prioritize activities to meet deadlines. 2. Detail oriented with ability to analyze quality data and identify trends. 3. Strong oral and written communication, presentation, and facilitation skills. 4. Strong computer and technology skills (including MS Excel, MS Word, MS PowerPoint, MS Teams, and MS Outlook). 5. Strong organizational skills with the ability to multi-task. 6. Ability to motivate and lead change management and performance improvement. 7. Ability to travel as required. JOB QUALIFICATIONS 1. Licensed (as required) health care professional preferred Registered Nurse 2. Certified Professional in Health Care Quality (preferred). 3. Knowledge of Medicare/Medicaid regulations, state licensure laws, and the requirements of any other applicable regulatory/accrediting body. 4. Experience with data collection, measurement tools, and data analysis. 5. Experience in a quality assurance/improvement SPECIAL INSTRUCTIONS TO CANDIDATES EOE/AA M/F/D/V
    $58k-70k yearly est. Auto-Apply 60d+ ago
  • Quality Improvement Specialist - Dental Offices

    Familia Dental & Vivid Smiles 3.9company rating

    Remote quality improvement specialist job

    Full-time Description About the Company Familia Dental believes everyone deserves access to quality, compassionate dental care, and that starts with having the right providers in the right places. Established in 2008 we have grown over the years because of our quality dentistry and our caring approach to all people. Our practice exemplifies the core values of quality, honesty, and care in everything that we do. When you join Familia Dental as a recruiter, you will have the opportunity to make a real difference in people's lives while earning a competitive base salary and significant commission opportunities. Job Purpose The Quality Improvement Specialist will review treatment documentation to ensure compliance with care standards and recommend process improvements. Responsibilities: Develop and manage comprehensive chart review projects, to evaluate clinical documentation, treatment effectiveness, and compliance. Review x-rays, patient charts and other patient records to ensure treatment/service provided is within guidelines of the standard of care guidelines. Review preauthorization paperwork to ensure the intended treatment meets the dental plan criteria and relevant program criteria. Proactively communicate with providers to request and obtain additional information or clarification as needed. Prepare reports for leadership committees highlighting key findings, trends and potential areas of improvement. Continuously update professional knowledge by leveraging available resources to stay current on dental plans, coverage options, and industry best practices. Recommend and assist in implementing corrective action plans and lead initiatives to enhance clinical quality, and documentation standards. May lead projects related to safety and compliance, providing strategic suggestions for process improvements. Other duties as may arise. Requirements Qualifications/ Skill Sets Ability to communicate effectively (verbal and written) persons of diverse backgrounds and educational levels. Excellent organization and interpersonal skills required. Excellent problem-solving skills to allow for the correct diagnosis of a problem along with potential solutions for resolution. Skilled in working with others in a team environment. Must be proficient in MS Office applications (Word, Excel, PowerPoint, and Access). Education and Experience Licensed Dental Hygienist preferred Minimum 5 years of experience in a clinical role or other similar related experience. Knowledge of dental procedures, terminology, and codes. Physical Requirements Ability to remain in a stationary position, sitting and/or standing, for extended time [e.g. sitting at a desk, working at a computer]. Benefits offered Health, Dental and Vision Insurance 401(k) Retirement Plan Paid Holidays & Time Off Access to Financial Advisors Basic Life & AD&D Insurance Voluntary Life Insurance Voluntary Short-Term & Long-Term Disability On demand Pay > Receive a portion of your check before payday! Availability / Schedule: full time, Monday - Friday Remote work Salary Description $70,000K and up depending on experience
    $48k-76k yearly est. 24d ago
  • ASPEN Trainer/QA SME Senior

    AHU Technologies Inc.

    Remote quality improvement specialist job

    Job Description: Short Description: The Senior Software Trainer and Quality Assurance Analyst is a hybrid training/QA role that is uniquely designed to provide schools with expert knowledge and training on the Districts Aspen SIS functions and support the DevOps team in testing. Complete Description: The Senior Software Trainer and Quality Assurance Analyst is a hybrid training/QA role that is uniquely designed to provide schools with expert knowledge and training on the Districts Aspen SIS functions and support the DevOps team in testing and validation new SIS features. The analyst is responsible for providing virtual and in person training and support to schools and central office users. They will provide virtual and in person support and training, in addition to telephone and email support to the end-user community. This role provides resolutions for users, walks the user through a series of steps to determine the cause of a problem, updates systems to reflect users requests, and creates training resources to support the ongoing use of the system. The role ensures problem ownership and promotes end-user satisfaction. Specific Duties 1. Create and maintains training resources (manuals, reference guides, webinars, websites) to support ongoing training using a number of mediums: PowerPoint, video, Captivate, Word, SharePoint, etc. 2. Provide virtual and in person training to central office and school-based staff (both at central office and at schools) 3. Interface with other teams on behalf of the training team to improve processes and relationships 4. Serve as the Tier II point of contact for support to resolve Aspen SIS user issues 5. Deliver the highest level of customer service to users 6. Log user inquiries in a ticket tracking system. Daily reviews any open issues or requests from end-users and follow-up accordingly. 7. Determine nature of obstacles and best DCPS staff to resolve, tracks and 10. Support and carries out the Chancellors mission to transform DC Public Schools and close the achievement gap. 11. Perform other related duties as assigned Duties for this role will also include: 1. Identifying and communicating with key stakeholders. 2. Gathering, reviewing, and analyzing business needs. 3. Liaising between various business departments and groups. 4. Assessing options for process improvement and testing of applications, as needed. 5. Maintaining documentation regarding various projects, processes, and operations. Required Skills and Experience 1. Required: 5 consecutive years of experience training users in Aspen SIS or other student information systems within DCPS or other educational settings. 2. Required: 2 years familiarity with help desk ticket tracking systems (Remedy, HEAT, etc.). 3. Required: 4 years of thorough knowledge of Aspen SIS capabilities 4. Required: 10 years providing excellent customer service, communication, interpersonal skills (both written and verbal) with emphasis on providing high quality customer service within a team environment 5. Required: 5 years producing training materials using video, Word, PowerPoint, Captivate 6. Ability to maintain professional communication skills when under pressure and exhibit a high level of patience. 7. Required: Must have a wide range of skills and knowledge in computer software and an understanding for network applications. 8. Required: Must have exposure to or experience in the education sector preferred. 9. Ability to quickly learn new processes and procedures 10. Ability to work independently in a fast-paced environment 11. Must be extremely well organized and detail oriented Skills Matrix Bachelors degree in IT or related field or equivalent experience Excellent customer service, communication, interpersonal skills (both written and verbal) Ability to maintain professional communication skills when under pressure and exhibit a high level of patience. Must have a wide range of skills and knowledge in computer software and an understanding for network applications. Producing training materials using video, Word, PowerPoint, and Camtasia, or Captivate SME in complex enterprise level projects Must have exposure to or experience in the education sector preferred. Must have knowledge of Adobe Captivate. Help Desk ticket tracking systems (remedy, HEAT, etc.) Student Information System - SIS capabilities 5 consecutive years of experience training users in Aspen SIS or other student information systems within DCPS or other educational settings. Flexible work from home options available.
    $56k-86k yearly est. 15d ago
  • Clinical Quality Improvement Coordinator

    University of Maryland Medical Center Baltimore Washington 4.3company rating

    Quality improvement specialist job in Largo, MD

    Conducts quality assurance compliance audits, reviews policies and procedures. Responsible for training new employees or existing employees, and implementing changes in work behavior or tactics. QI Coordinator monitors and manages projects that directly impact the facility's performance while capturing metrics, statistics or data from personnel or work outcome. Principal Duties: 1. Supports systems designed to promote hospital-wide performance improvement. Via Review of Medical Record for issues related to quality and performance a. Performs concurrent and retrospective review of core measure patients and/or quality indicators in compliance with National Hospital Inpatient Quality Measures, Vermont Oxford Network and regulatory agencies such as Joint Commission, CMS, HQID project, MIEMSS, DHMH, HSCRC, etc. b. Knowledgeable about core measures, Vermont Oxford Network Data, etc., informing director of changes in protocol/data requirements and implications for clinical practice c. Participates in the education of medical staff, employees, leadership and Board on quality and performance indicators selected by the organization as well as the requirements and implications of these measures for clinical practice d. Performs retrospective and concurrent review of specific focused studies (including procedures, diagnosis and other studies) requested by medical staff, hospital departments and committees e. Flags and documents variances for selected indicators and variables for focused studies and implements indicators for medical staff and peer review including OPPE and FPPE as required by TJC f. Participates in data extraction for submission of required data electronically to Vermont Oxford, MIEMSS, NAS Collaborative and DHMH. Facilitates the organization's responses in order to meet established time frames for submission g. Collects, interprets and reports data at specified intervals with accuracy and completeness h. Demonstrates proficiency in abstraction and interpretation of data reports 2. Interpretation of Clinical Data a. Identifies and interprets objective and subjective data found in the medical records b. Compares the identified data to established criteria to determine appropriateness of care c. Abstracts and reports PI information in appropriate format to detect patterns and/or problems in the delivery of care d. Identifies potential areas for change and improvement of the study design and data collection and makes recommendations e. Develops new ongoing quality projects and evaluates the appropriateness of indicators and criteria for quality monitoring 3. Development and maintenance of knowledge including Committee, Collaborative and Team Support a. Maintains current knowledge of PI strategies, principles, methodologies, techniques and data analysis. b. Maintains current knowledge of TJC, CMS, national quality indicator guidelines, Magnet, NANN, AWHONN, NAN and NDNQI and assesses compliance for assigned areas. c. Works with Leaders, Chiefs, Vice Chiefs and service line specific as well as facility Committee Chairs to organize and accomplish goals of required committee meetings, collaboratives and teams d. Executes effective improvement projects through multidisciplinary team collaboration e. Active participant in service line committee/council meetings and proactively provides reports and information as required by the committee or team and meets 90% attendance f. Assures that issues are communicated to appropriate committees or individuals and that issues have timely resolution g. Maintains peer review information in strict confidentiality and assures entry into database and PI file h. Coordinates assigned meetings, assisting with agenda and providing all data metrics from various committees. 4. Provides continued improvement consulting services to customers a. Evaluates referrals to the Quality Department. Refers issues to appropriate department Risk Management, Infection Control and Pharmacy. Follow up as needed. b. Maintains confidentiality of QA material c. Participates in CQI teams to improve organizational performance such as FMEA, RCA. Customer Service: 1. Greets customers in courteous, friendly, respectful and professional manner at all times, including maintaining eye contact when appropriate. 2. Follows communication protocols to both internal and external customers, including introducing him/herself with job title and experience, asking open ended questions, such as "How may I be of help to you?" using the customer's name as soon as it is learned. 3. Responds promptly and appropriately to customer questions/concerns/complaints and attempts immediate resolution. 4. Keeps customer's information confidential, including public places such as elevators or the cafeteria. 5. Provides assistance and offers help immediately, including finding someone else to meet the request, if unable to do so him/herself. Introduce other staff to customers when a hand-off occurs and explain that the person will provide excellent service. 6. Demonstrates commitment to excellent service recovery when a customer's expectations have not been met. Commitment to Co-Workers: 1. Offers assistance to colleagues and other departments when needed. 2. Takes responsibility for solving problems regardless of origin; completes assignments, and respects deadlines. 3. Resolves conflict directly with colleagues and seeks assistance from others if the issue cannot be resolved. Refrains from criticism in public. 4. Mindful and respectful of others' time and schedules. Attends meetings on time and communicates any absences. 5. Provides co-workers with a status report for continuity of workflow when planning to be out of the office, off the unit, or away from the department Communication Etiquette: 1. Respectful, courteous and professional in all forms of communication and follows facility's service communication protocol in all interactions. 2. Refrains from use of personal cell phone in patient care areas and keeps usage to a minimum at all other times while on duty. 3. Does not text or use e-mail during meetings (except for exigent or emergency situations). 4. Limits use of business cell phone during meetings (remain on vibrate and/or calls go to voicemail). 5. Makes every effort to answer telephone calls within three rings, introducing him/herself, department and title (if appropriate). Asks permission before placing the caller on hold or using the speakerphone. If caller is transferred, gives the caller the extension number of the person he or she is being transferred to. Offers further assistance to the caller upon completing the conversation. 6. Maintains an appropriate voicemail message and when away from the office has an out-of-office email message that is brief, current, and includes name and department and offers the caller options if possible. 7. Returns email and voicemail messages promptly but no later than within one business day (24 hours). 8. Always mindful of voice and language in public. Self Management: 1. Reports to work appropriately groomed and in compliance with the Hospital's dress code. Wears identification badge at all times at chest level and facing outwards so identification is clearly visible. 2. Complete all assignments within deadlines or negotiates alternative actions and time frames in order to achieve desired outcomes. 3. Completes mandatory, annual education and competency requirements. 4. Follows UMCAP safety, infection control and employee health standards. 5. Demonstrates responsibility for personal growth, development and professional knowledge and competency. 6. Adhere to all UMCAP and department policies and procedures, including Code of Conduct and professional behavior standards. Does not exceed Hospital guidelines in reference to attendance, punctuality, and use of sick and unplanned absences. Provides notification of absences, lateness and vacation requests according to department guidelines. Respects length of time for lunch and break times. 7. Reviews, signs, and adheres to UMCAP and/or departmental confidentiality statement. Company Description Located in Largo in the heart of Prince George's County, our new state-of-the-art regional medical center (UM Capital Region Medical Center) will provide improved access to primary and ambulatory care services, and serve as a tertiary care center for critically ill patients. In addition, our new space will allow us to expand our offerings as a community partner to help improve the health status of Prince George's County residents. Qualifications POSITION REQUIREMENTS: Licensure/Certification/Registration Required: Current Maryland license in good standing as Registered Nurse. Education/Knowledge Attained Level: Professional Required: Bachelors of Science in Nursing. Masters preferred Completed Course Work/Program: Graduation from an accredited school of nursing. Applicable Experience Experience (years): Required: 5 - 7 years Experience (describe required & preferred): * 5 years clinical experience * At least 2 years (combined) QA, QI, RM, UR, CM experience Technical/Clinical Skills Microsoft Office Suite Skill Level Word: Basic Excel: Basic Working knowledge of ICD-9 (Medical Coding) Basic knowledge and working experience with Medical Terminology Standard Office Equipment (list): Computer, facsimile, Answering Machine Other: PBX Communication Skills & Abilities (see attached explanation sheet) Select highest applicable level: Effective Oral/Written Skills and Provide Empathy Language: English Problem Solving/Analytical Skills & Abilities: Professional/Supervisory Additional Information All your information will be kept confidential according to EEO guidelines. Compensation: * Pay Range: $44.76 - $67.19 * Other Compensation (if applicable): * Review the 2025-2026 UMMS Benefits Guide Like many employers, UMMS is being targeted by cybercriminals impersonating our recruiters and offering fake job opportunities. We will never ask for banking details, personal identification, or payment via email or text. If you suspect fraud, please contact us at ****************.
    $44.8-67.2 hourly 6d ago
  • Neighborhood Improvement Specialist II (Code Inspector) Full-Time

    Town of Riverdale Park 3.9company rating

    Quality improvement specialist job in Riverdale Park, MD

    The Position: Under general supervision, this is an intermediate position that involves inspections, community engagement, problem-solving, and enforcement of the Town's community standards. The community standards, commonly referred to as codes, apply to all residential and commercial properties, establish minimum requirements for the upkeep of properties, and technical requirements in the built environment. As part of the ONS Team, the Neighborhood Improvement Specialist II is tasked with improving neighborhood quality of life, improving safety in the built environment, and encouraging active participation in neighborhood redevelopment. Most of the time is spent in the field, having daily contact with property and business owners, tenants, community stakeholders, and neighborhood groups. The position requires managing an active caseload, negotiating improvement plans, ensuring timely follow-up, abatement of deficiencies, and encouraging neighborhood improvement participation. Compensation: The starting salary range is $50,939 to $56,222; depending on qualifications. The Town offers competitive health care benefits, a leave package, and excellent retirement plan options. The Town offers $2,080 per year for bilingual speaking and writing English-Spanish skills in addition to base pay. Supervision Received: Work is assigned and performed under the general supervision of the Director of Development Services. Supervision Exercised: None. Ideal Candidate: The ideal candidate will be seeking an exciting opportunity to assist in creating change throughout the Town's neighborhoods and business areas. A minimum of a Bachelor's degree is required. A bachelor's degree in engineering, construction management, architecture, or public administration is highly preferred. A combination of relevant experience and education may substitute. Demonstrated experience must include at least two (2) years in community engagement, planning, code or law enforcement, licensing/permitting, familiarity with building development/construction, municipal operations, or related work. Proficiency in Microsoft Office is required. Also, the ideal candidate must have the following abilities: Communicate (verbally and in written form) effectively with a diverse community and workplace; interacting with a broad range of stakeholders Interpret and implement local policies and procedures; written instructions, general correspondence, and Federal, State, and local regulations Maintain discretion regarding files, reports, and conversations, within the provisions of the Maryland Public Information Law and other applicable State and Federal regulations A high degree of comprehension, memory recall, and analytic ability involving technical and complex requirements Define problems and deal with a variety of situations to think quickly, maintain self-control, and adapt to stressful situations Multitask and prioritize requests and projects to meet deadlines, and organize work independently Within six (6) months of employment, the successful candidate must obtain and maintain certification as a Property Maintenance/Housing Inspector from the International Code Council. The Town provides training. Lastly, the candidate must maintain a valid Class D vehicle operator's license and satisfactory driving record. Department: Neighborhood Services encourages owners and tenants to work with the Town and our partners to meet or exceed compliance with the Town's codes and community standards to ensure safe and well-maintained homes, businesses, and neighborhoods. These efforts protect investments, enhance the quality of life throughout the Town, and add to the curb appeal of TRP to ensure that the Town is the location of choice for residents, businesses, visitors, and investors. The regulatory programs involve licensing, permits, and inspection. The Office comprises two (2) neighborhood improvement specialists reporting to and working with the Director of Development Services. A centralized Office of Administrative Services provides program management and support services. PHYSICAL REQUIREMENTS AND ACTIVITIES: This position requires light physical work requiring lifting up to 25 pounds and lifting and carrying up to 10 pounds. Physical activities include stooping, pulling, lifting, reaching, grasping, and repetitive motions. Walking, standing, and mainly sitting at will but maybe for long distances and sustained periods of time. At times, this movement will be over uneven or rough terrain. Includes the necessity to communicate by talking, hearing/listening. This job's specific vision abilities include close, distance, and peripheral vision; depth perception; and the ability to adjust focus. The Community: The Town of Riverdale Park is a growing community. The Town is situated between the City of Hyattsville and the City of College Park, Maryland. The Town's population is approximately 7351. The Town is experiencing significant development and is poised for additional development as two Purple-Line Stations will be constructed within the Town. The Town operates under a Council-Manager form of government. The Town's elected leadership is comprised of a Mayor and six (6) Council Members. The Mayor serves as the chair of the Council, the legislative branch of the Town government. The Town's staff leadership team reports to the Town Manager. Challenges / Opportunities: This is an exciting opportunity to positively impact the built environment and the Town's quality of life. Like many departments in small-to-mid-sized towns experiencing growth, the ONS faces challenges associated with evolving expectations, leading change, transitioning to data-driven decision-making, improving policy and process implementation, and enhancing community services within operational and budgetary constraints. Process: To apply, click the tab (below or right). Applicants are required to submit a resume, cover letter, and three (3) professional references through this application portal. The position is open until filled. Applications will be reviewed on a continual basis. The Town of Riverdale Park is an Equal Opportunity Employer. The Town provides equal opportunity to all qualified applicants based on demonstrated fitness and merit as determined through the selection process without regard to sex, race, color, religion, gender, gender identity, marital status, national origin, ancestry, sexual orientation, age, mental or physical disability (as defined in the Americans with Disabilities Act), or any other basis protected by federal or state law, ordinance or regulation.
    $50.9k-56.2k yearly 36d ago
  • Quality Performance Evaluation Specialist

    Associated Administrators 4.1company rating

    Remote quality improvement specialist job

    The quality performance evaluation (QPE) specialist is a key contributor to maintaining and enhancing the customer experience across our operations. This role is responsible for assessing customer interactions to ensure alignment with quality standards, regulatory compliance, and customer excellence. By analyzing performance trends and identifying areas for improvement, the QPE Specailist that success in this role requires strong analytical capabilities, attention to detail, and a commitment to driving high-quality customer engagements. "Has minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) by /Role." Key Duties and Responsibilities Monitor and evaluate inbound and outbound customer interactions across multiple channels (phone, chat, email) for quality, compliance, and adherence to internal standards. Document audit findings and deliver clear, constructive feedback to frontline agents and supervisors. Identify trends, gaps, and opportunities for improvement in agent performance and customer experience. Collaborate with learning and development, operations, and leadership teams to support coaching, development, and process improvement initiatives. Participate or facilitate calibration sessions to ensure consistency and fairness in quality evaluations. Provide weekly quality performance evaluation coaching session for operations teams. Maintain accurate records of audits and contribute to regular reporting on quality metrics and KPIs. Assist in the development and refinement of quality scorecards, evaluation criteria, and audit tools. Stay current on industry best practices, compliance requirements, and customer service standards. Performs other related duties and special projects as needed. Minimum Qualifications High School Diploma or GED. Two years of experience in training and material development. Exceptional team player with the confidence and integrity to earn client and internal team confidence quickly. Excellent verbal and written communication skills, including interpersonal skills. Strong decision-making and organizational skills, with the ability to optimize the use of all available resources and delivery on multiple priorities. Exceptional analytical and problem resolution skills; ability to exercise independent and, sound judgment. Experience facilitating in person and virtual classrooms with proficient presentation skills. Proficiency with MS Office tools and applications. Some travel may be required. Preferred Qualifications Prior multi-employer and Taft-Hartley trust fund experience. Bachelor's degree in training or educational related field. Certification in training, learning, development, or quality. Experience with speech analytics or quality monitoring software. Familiarity with regulatory compliance standards (e.g., HIPAA, PCI-DSS, FDCPA) depending on industry. Bilingual or multilingual capabilities are a plus Working Conditions/Physical Effort Normal degree of physical effort in a typical office environment with comfortable, constant temperatures and absence of objectionable elements. Able to lift up to 15 pounds. May be required to work remotely. *Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee of this job. Duties, responsibilities and activities may change at any time with or without notice. Disability Accommodation Consistent with the Americans with Disabilities Act (ADA) and other applicable federal and state law, it is the policy of Zenith American Solutions to provide reasonable accommodation when requested by a qualified applicant or employee with a disability, unless such accommodation would cause an undue hardship. The policy regarding requests for reasonable accommodation applies to all aspects of employment, including the application process. If reasonable accommodation is needed, please contact the Recruiting Department at ******************************, and we would be happy to assist you. Zenith American Solutions Real People. Real Solutions. National Reach. Local Expertise. We are currently looking for a dedicated, energetic employee with the necessary skills, initiative, and personality, along with the desire to get the most out of their working life, to help us be our best every day. Zenith American Solutions is the largest independent Third Party Administrator in the United States and currently operates over 44 offices nationwide. The original entity of Zenith American has been in business since 1944. Our company was formed as the result of a merger between Zenith Administrators and American Benefit Plan Administrators in 2011. By combining resources, best practices and scale, the new organization is even stronger and better than before. We believe the best way to realize our better systems for better service philosophy is to hire the best employees. We're always looking for talented individuals who share our dedication to high-quality work, exceptional service and mutual respect. If you're interested in working in an environment where people - employees and clients - really matter, consider bringing your talents to Zenith American! We realize the importance a comprehensive benefits program to our employees and their families. As part of our total compensation package, we offer an array of benefits including health, vision, and dental coverage, a retirement savings 401(k) plan with company match, paid time off (PTO), great opportunities for growth, and much, much more!
    $61k-94k yearly est. Auto-Apply 36d ago
  • Quality Specialist (South)

    Olipop

    Remote quality improvement specialist job

    At OLIPOP, we're on a mission to positively impact consumer health at scale. And we're doing it through something simple: soda. But not just any soda, a new kind of soda: one that's delicious, refreshing, and actually good for you. This mission is deeply personal for our CEO, Co-Founder, and Formulator, Ben Goodwin. Like many of us, Ben grew up consuming the Standard American Diet: lots of soda and processed foods that prioritized convenience over nutrition. But at 14, he took his health into his own hands. After making significant changes to his nutrition and exercise, he lost 50 pounds and saw a transformation in his energy, mood, and emotional clarity. Those changes sparked a deep curiosity about the connection between nutrition and health. Ben became a relentless student of the gut microbiome and the ways it supports overall wellness. The more he discovered, the more passionate he became about finding credible, science-backed ways to make consumer health accessible to everyone. The mission was clear. The vehicle? Less so. After exploring the possibilities, Ben landed on an unexpected yet familiar choice: soda. It was something he loved as a kid, and he knew millions shared that same nostalgia. But this wouldn't be just any soda. With most Americans falling short on daily fiber, Ben set out to create a version with more fiber and less sugar, one that was perfectly balanced. The result? A deliciously refreshing soda with 6 to 9 grams of fiber and 2 to 5 grams of sugar, delivering science-backed benefits without sacrificing the classic taste people crave. In 2018, the first OLIPOP cans hit the shelves, bringing Ben's vision to life with a functional soda that anyone could enjoy. And by reimagining soda, we're also reshaping culture. That means creating products that support health for all and building a business grounded in humanistic values: empathy, integrity, and a belief in better for everyone. From the ingredients we source to the culture we foster, we're committed to proving that business (and beverage!) can be a force for good, and that soda has the power to bring people together. So join us, and let's write a new American soda story together. One we can all feel good about. One OLIPOP at a time. THE ROLE In this role, under the supervision of the Senior Quality Manager the Quality Specialist will be a liaison between OLIPOP and our regionally based third party partners such as copackers, warehouses, suppliers, blending facilities, and repacking facilities. Regular onsite presence at these locations is required to observe conformance to specifications, upholding OLIPOP's quality systems, and to ensure finished products meet the highest standards of quality and consistency. Candidates based in Dallas, TX or within commutable distance are strongly preferred RESPONSIBILITIES Copacker Management Manage copacker corrective action program by gathering all relevant information and documentation for investigations and incidents. Interact effectively with all copacking partners to maintain positive & responsive relationships in collaboration with Sr. Coman Manager. Onsite presence to observe production in real time. Evaluate production data (Brix, pH, CO2, seam checks, etc), attend qualification trials, and uphold OLIPOP's quality standards. Attend weekly copacker meetings to discuss quality related topics. Monitor copacker performance as it aligns with Supply Chain KPIs. Assist Coman Manager in onboarding new copacking partners within the region. Warehouse Management Interact effectively with all warehouse partners to maintain positive & responsive relationships Coordinate with OLIPOP 3PL's and the Supply Chain team to manage the positive release program for all OLIPOP products Coordinate product holds and traceability exercises. Quarterly visits or on an as needed basis. Assist Warehouse Manager in onboarding new third party warehouses. Document Control Maintain OLIPOP document control systems (version, approvals etc.) for all regionally based third party partners. Assist Supply Chain team members in the creation and proper formatting of documents. Organize and archive documents as necessary. Review all SOPs for completeness and accuracy with stakeholders on a regular basis. REQUIREMENTS: 3-5 years of Quality Assurance & Quality Control experience in food & beverage manufacturing. Beverage experience preferred. Experience developing and implementing document control processes. High level of proficiency in Microsoft Excel or Google Sheets are required. Good organizational skills and ability to handle complex situations involving multiple SKU's, channels, and distribution models. Transparent, open/honest communicator - a great listener who can work independently while keeping other team members informed Strong attention to detail and deadline oriented with the ability to organize assignments, set priorities, and carry out plans. Estimated 50% travel to copacker, supplier or team events as required. Candidates based in Dallas, TX or within commutable distance are strongly preferred. REPORTS TO: Senior Quality Manager COMPENSATION: $70,000-$85,000 base salary + bonus HOW WE WORK We may be fully remote, but we're anything but disconnected. OLIPOP has grown from a few passionate people around a table to a nationwide team, and we've done it without losing our collaborative spirit or sense of purpose. Connection here is intentional. From cross-functional projects and IRL offsites to thoughtful Slack threads and spontaneous gifs, we make the effort to stay close, even across time zones. Sure, we move quickly, but we lead with trust, transparency, and a shared commitment to doing work that matters. We value thoughtful debate. We give feedback with care and receive it with curiosity, knowing that real growth, both personal and collective, comes from listening as much as leading. Because at OLIPOP, it's not just about getting things done. It's about growing together, staying true to what matters, and building something with lasting impact. WHAT WE VALUE At OLIPOP, our values aren't just posters on a wall. They shape how we show up: for each other, for our customers, and for the mission we're chasing together. Mission Connectivity: Everything we do ladders up to our shared goal: supporting human health. Whether launching a new flavor or conducting clinical research, the mission stays front and center. Indomitable Spirit: When things get messy, we get inventive. We stay curious, adapt quickly, and find the path forward, most likely with a dedicated Slack thread and a beautifully overbuilt deck. Lead at Every Level: Leadership isn't about titles, it's about ownership. We speak up, follow through, and lift each other up. If you've got ideas and initiative, you've got influence. Courageous Humility: We're confident in what we bring and curious about what we don't know (yet). We give feedback with care, take it with grace, and know that real growth takes both. WHAT WE'RE LOOKING FOR Success at OLIPOP doesn't come from checking boxes; it comes from living our values, staying curious, and finding energy in both the pace and the purpose. We're building something big, and we're looking for people who: Think big, move fast, and take thoughtful risks Thrive in a high-performance, feedback-rich environment Value real human connection and honest collaboration Are fired up by building something new, and making it better every day Startup life at OLIPOP is equally fun and fast-paced. If you're energized by a dynamic environment, eager to grow, and excited to help shape something meaningful from the inside out, OLIPOP is a one-of-a-kind ride. We are committed to providing reasonable accommodations to qualified individuals with disabilities or other needs during the application process and employment. To request an accommodation, please contact The People Team at **************************. We are proud to be an Equal Opportunity Employer. OLIPOP will consider all qualified applicants without regard to race, religion, gender (including pregnancy and gender identity), national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, veteran status, or any other characteristics protected by law. Submission of Application Materials Applicants are required to submit only the materials specifically requested as part of the application process. Please do not include any unsolicited materials, as they will not be reviewed or considered. Unsolicited materials may include, but are not limited to: Marketing or promotional concepts Business ideas or strategies Photographs, videos, or other media Presentations, designs, or other creative content By submitting any materials beyond those explicitly requested, you agree that: You are voluntarily providing such materials; You irrevocably assign all rights, title, and interest in and to those materials to Olipop Inc.; and Olipop Inc. may use, reproduce, modify, distribute, or otherwise exploit such materials for any purpose anywhere in the world, without restriction or compensation.
    $70k-85k yearly Auto-Apply 24d ago
  • Lead Inpatient Quality Specialist

    Corrohealth

    Remote quality improvement specialist job

    About Us: Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success. JOB SUMMARY: CorroHealth is seeking a Lead Inpatient Quality Specialist. ESSENTIAL DUTIES AND RESPONSIBILITIES: Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member's performance objectives as outlined by the Team Member's immediate Leadership Team Member. Performs complex retrospective analysis of medical record documentation to identify coding and billing errors and inconsistencies according to guidelines of the AHA, CMS, AMA, Clinic Coding Clinic and CPT Assistant. Analyzes audit findings to identify potential root causes of coding errors and prevent their reoccurrence Provides second -level review of diagnosis, procedure and billing codes to ensure compliance with legal and procedural policies that ensure optimal reimbursements while adhering to regulations prohibiting unbundling and other questionable practices. Research, analyze and respond to inquiries regarding compliance, inappropriate coding, denials and billable services Provides technical support and feedback training to internal coding staff regarding coding compliance, documentation, regulatory provisions, third part payer requirements, medical necessity requirements Protects the privacy and confidentiality of patient health and client information. Follows the Standards of Ethical Coding as set forth by AHIMA and adheres to official coding guidelines and compliance practices. Suggests physician query opportunities query Physicians based upon documentation and clinical needs. Prepare deliverables for the coders as required Report work time and work productions in a timely and accurate manner Communicates with coworkers in an open and respectful a manner which promotes teamwork and knowledge sharing. Provide schedule of planned work activities, events and sites, and any changes to same to management and appropriate staff. Maintenance of professional coding credentials and knowledge of coding, reimbursement methodologies and compliance issues through education Monitor the on-going progress and success of each coder Maintain QA percentages within two internal quality goals; 1) overall minimum coder accuracy of 95% and 2) QA review percentages as close to 10% as possible Identify and resolve coding quality problems or issues in a timely manner Maintain a continual knowledge of problems or issues that could affect coding quality levels Assist in design of systems to help improve coder productivity and assist in improving accuracy of coding Provide monthly reports Participate in corporate training and meetings Provide status reports to senior manager as requested Align conduct with AHIMA's Standards of Ethical Coding and the Company's Code of Ethics and Business Conduct and support the Company's Ethics and Compliance Program Interpret coding guidelines for accurate code assignment Identify the importance of documentation on code assignment and the subsequent reimbursement impact Comply with all internal policies and procedures Actively participate in Company provided training and education Ensure individual compliance with all privacy and security rules and regulations and commit to the protection of all Company confidential information, including but not limited to, Personal Health Information Qualifications and Requirements: Regular, predictable and punctual attendance is required Strong verbal and written communication skills are required Ability to prioritize workload, meet deadlines and maintain a high level of quality and accuracy Recognized coding credential from AHIMA or AAPC; and RHIA or RHIT may also be considered Experience with telecommuting and electronic medical records systems strongly preferred Strong analytical skills Excellent written communication skills Strong team player Ability to work with multiple and diverse clients and projects Ability to work with minimal supervision 5-7 years' experience coding and/or auditing in an acute care facility or clinic, of patient types listed in the Job Summary of this document Initiative, resourcefulness and attention to detail Customer service support -- minimum one (1) year experience Familiarity with hospital outpatient billing processes Understand hospital APC assignment and associated coding and documentation Coding Certification -- preferred (CPC or CCS) Strong communication skills, proficient in Microsoft Office applications including Word and Excel Ability to navigate in a variety of EMR environments and review hand-written charts PHYSICAL DEMANDS: Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines. A is only intended as a guideline and is only part of the Team Member's function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.
    $52k-80k yearly est. Auto-Apply 60d+ ago
  • Quality Improvement Coordinator - RN or LPN Preferred (28875)

    Bridgepoint Healthcare 4.4company rating

    Quality improvement specialist job in Washington, DC

    QUALITY IMPROVEMENT COORDINATOR BRIDGEPOINT CONTINUING CARE HOSPITAL At BridgePoint, whether you work with patients every day or support those who do, you are making a difference that matters. We know the path to recovery doesn't happen alone. As a team, we work cohesively to meet each patient's unique needs. We are a team-driven environment and we care about our own! Our employees form the foundation of everything we do - optimizing patient healing and wellness, and creating a warm and welcoming environment. It is because of the dedication of our employees that we can live out our mission, vision, and company values every day. It is at BridgePoint where care, community, and careers happen. QUALITY IMPROVEMENT COORDINATOR JOB SUMMARY: The Quality Improvement Coordinator works with the Director of Quality to plan, organize, direct and lead staff, and process quality improvement programs. The Quality Improvement Coordinator requires understanding and can use techniques of system design, reengineering, project management, quality improvement, outcome measurement and analysis. The Quality Improvement Coordinator assists in providing leadership in all aspects of Quality Management including establishing a systematic approach to Quality Management, setting priorities, providing direction and mentoring to staff, providing leadership for patient safety initiatives, monitoring progress, evaluating and continuing to improve the quality system. The Quality Improvement Coordinator works to minimize the hospital's potential financial loss through risk detection, evaluation, and prevention programs in collaboration with Risk Manager and Director of Quality. The Quality Improvement Coordinator coordinates the development, implementation, and evaluation of the hospital's overall Quality Improvement (QI) program, which includes all ancillary, nursing, and medical staff departments, to identify trends, prioritize and recommend improvements, decrease duplication, and ensure regulatory and licensure compliance, contractual obligations and corporate policies on QI program. The Quality Improvement Coordinator investigates incident reports, patient complaints, patient care issues, and other issues as requested. CIHQ, CPHQ, Six Sigma, Healthcare Quality, Hospital Quality, Skilled Nursing Quality, Quality Coordinator, Quality and Risk Management, Quality Management, Regulatory Healthcare, LPN, RN, Nurse, Therapist, RT Qualifications Education: College degree in clinical area. Licenses/Certification: ASQ or CPHQ certification preferred Licenses/Certification: Must have at least two (2) years' experience in acute hospital setting, with responsibilities including data collection and reporting preferred. Must be proficient in Microsoft Office applications Safety Sensitive-Designated Positions About BridgePoint BridgePoint Healthcare is dedicated to promoting healing and wellness in a safe and welcoming environment, with an individualized path to recovery for each patient. BridgePoint Healthcare provides patient-centered, individualized care for patients requiring longer hospitalizations in post-acute care settings. We are a diversified provider of post-acute care in settings ranging from long-term acute care hospitals to skilled nursing facilities. Our locations include two in Washington, DC (BridgePoint Hospital National Harborside and BridgePoint Hospital Capitol Hill), and one in New Orleans (BridgePoint Continuing Care Hospital - West Jefferson Campus).
    $69k-95k yearly est. 16d ago
  • Hospital Coding Quality Specialist - Inpatient REMOTE

    Advocate Health and Hospitals Corporation 4.6company rating

    Remote quality improvement specialist job

    Department: 13244 Enterprise Revenue Cycle - Facility Coding Quality Integrity Status: Full time Benefits Eligible: Yes Hours Per Week: 40 Schedule Details/Additional Information: First shift This is a REMOTE opportunity. Desire: Hospital Inpatient coding experience Pay Range $28.05 - $42.10 Major Responsibilities: Reviews coded health information records to evaluate the quality of staff coding and abstracting, verifying accuracy and appropriateness of assigned diagnostic and procedure codes, as well as other abstracted data, such as discharge disposition. Ensure accurate coding for outpatient, day surgery and inpatient records. Verifies all codes and sequencing for claims according to American Hospital Association (AHA) coding guidelines, CPT Assistant, AHA Coding Clinic and national and local coverage decisions. Works collaboratively with coding leadership per their direction in reviewing records with focused diagnosis and procedure codes, including specific APCs, DRGs and OIG work plan targets to assure compliance in all areas of coding, which may give visibility into documentation that is driving codes. Works collaboratively with coding leadership to identify focused prospective records that need to be reviewed. Identifies coder education opportunities, team trends, and consideration of topics to mandate for second level account review, before the account is final coded. Reviews encounters flagged for second level review, including but not limited to; hospital acquired conditions (HACs), complications and other identified records such as core measures or trends as identified by coding leadership. Perform review of coded encounter for appropriate risk-adjustment, including accurate severity and risk of mortality assignment. Responsible for coding participation in the Clinical Documentation Improvement and Hospital Coding alignment process. Review accounts with mismatched DRG assignment following notification from the Inpatient coder. Determine the appropriate DRG based on coding guidelines. Provide follow up to the clinical documentation nurse with rationale on final outcome. Recommends educational topics for coders and clinical documentation nurses based on their observations from reviewing mismatches. Participate in hospital coding denial and appeal processes as directed. Ensure timely review and response to any third-party payer notification of claims where codes are denied. Determine if an appeal will be written based on application of coding guidelines and provider documentation. Following review of overpayment or underpayment denials, provide appropriate follow-up to coding team member as appropriate, rebilling accounts to ensure appropriate reimbursement. All trends identified should be presented to coding leadership in a timely manner and logged for historical tracking purposes. Investigates and resolves all edits or inquiries from the billing office or patient accounts, to prevent any delay in claim submission due to open questions related to coding. Identifies any coding issues as they relate to coding practices. Clarifies changes in coding guidance or coding educational materials. Maintains continuing education credits and credentials by keeping abreast of current knowledge trends, legislative issues and/or technology in Health Information Management through internal and external seminars. Identify opportunities for continuing education for hospital coding team. Licensure, Registration, and/or Certification Required: Coding Specialist (CCS) certification issued by the American Health Information Management Association (AHIMA), or Health Information Administrator (RHIA) registration issued by the American Health Information Management Association (AHIMA), or Health Information Technician (RHIT) registration issued by the American Health Information Management Association (AHIMA), or Education Required: Associate's Degree in Health Information Management or related field. Experience Required: Typically requires 5 years of experience in hospital coding for a large complex health care system, which includes hospital coding, denial review and/or coding quality review functions. Knowledge, Skills & Abilities Required: Demonstrated leadership skills and abilities. Demonstrates knowledge of National Council on Compensation Insurance, Inc. (NCCI) edits, and local and national coverage decisions. Expert knowledge and experience in ICD-10-CM/PCS and CPT coding systems, G-codes, HCPCS codes, Current Procedural Terminology (CPT), modifiers, and Ambulatory Patient Categories (APC), MS-DRGs (Diagnosis related groups) Advanced knowledge in Microsoft Applications, including but not limited to; Excel, Word, PowerPoint, Teams. Advanced knowledge and understanding of anatomy and physiology, medical terminology, pathophysiology (disease process, surgical terminology and pharmacology.) Advanced knowledge of pharmacology indications for drug usage and related adverse reactions. Expert knowledge of coding work flow and optimization of technology including how to navigate in the electronic health information record and in health information management and billing systems. Excellent communication and reading comprehension skills. Demonstrated analytical aptitude, with a high attention to detail and accuracy. Ability to take initiative and work collaboratively with others. Experience with remote work force operations required. Strong sense of ethics. Physical Requirements and Working Conditions: Exposed to a normal office environment. Must be able to sit for extended periods of time. Must be able to continuously concentrate. Position may be required to travel to other sites; therefore, may be exposed to road and weather hazards. Operates all equipment necessary to perform the job. This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties. #REMOTE #LI-REMOTE Our Commitment to You: Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more - so you can live fully at and away from work, including: Compensation Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training Premium pay such as shift, on call, and more based on a teammate's job Incentive pay for select positions Opportunity for annual increases based on performance Benefits and more Paid Time Off programs Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability Flexible Spending Accounts for eligible health care and dependent care expenses Family benefits such as adoption assistance and paid parental leave Defined contribution retirement plans with employer match and other financial wellness programs Educational Assistance Program About Advocate Health Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation's largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.
    $28.1-42.1 hourly Auto-Apply 60d+ ago
  • Bilingual Customer Quality Specialist

    ASM Research 4.2company rating

    Remote quality improvement specialist job

    The Quality Assurance (QA) Specialist is responsible for analyzing the efficiency and effectiveness of individual case analysts. The QA Specialist reviews cases, interactions and evaluates them for compliance with standardized process requirements in both English and Spanish languages. Key Responsibilities: The QA Specialist reviews cases, emails, and recorded telephonic interactions and evaluates them for compliance with standardized process requirements. Requirements may include soft skills in phone calls, clear communication in emails, and an adherence to directive in case work. Based on the review, the Quality Analyst provides a concise written analysis of the work reviewed along with feedback and coaching recommendations to improve the performance of the program. Required minimum qualifications: Bachelor's Degree or equivalent OR 4 years of relevant experience in lieu of degree. Experience following defined processes. Must be a US Citizen or Authorized to work in the US (if not a citizen) and a resident of the US for at least 3 years within the last 5 years. Must have fluent written and verbal English and must be fluent verbal Spanish. Candidates that do not meet the required qualifications will not be considered Preferred qualifications: Experience with CMS's 1095-A Advanced proficiency with MS Office including SharePoint, Teams, Excel, Word, and PowerPoint Strong verbal and written communication skills Familiarity with process improvement systems such as Lean Six Sigma, Agile, and others. Previous Federal Government experience.
    $57k-80k yearly est. 22h ago
  • Quality Specialist

    Rush University Medical Center

    Remote quality improvement specialist job

    Business Unit: Rush Medical Center Hospital: Rush University Medical Center Department: Patient Access-Pre-Visit Work Type: Full Time (Total FTE between 0.9 and 1.0) Shift: Shift 1 Work Schedule: 8 Hr (8:00:00 AM - 4:30:00 PM) Rush offers exceptional rewards and benefits learn more at our Rush benefits page (***************************************************** Pay Range: $20.19 - $31.80 per hour Rush salaries are determined by many factors including, but not limited to, education, job-related experience and skills, as well as internal equity and industry specific market data. The pay range for each role reflects Rush's anticipated wage or salary reasonably expected to be offered for the position. Offers may vary depending on the circumstances of each case. Summary: The Quality Assurance (QA) Specialist is responsible for performing quality monitoring to ensure Patient Access staff are adhering to expected workflows, internal policies, registration across the organization and external regulatory requirements. The QA Specialist is a remote position supporting across departmental processes. This position will work closely with Patient Access leadership. This position will provide support for both onsite and remote staff. Exemplifies the Rush mission, vision and values and acts in accordance with Rush policies and procedures. Other information: Required Job Qualifications: * High school graduate or equivalent * 1-2 years of experience * Experience within a hospital or clinic environment, a health insurance company, managed care organization or other health care financial service setting * Must have a basic understanding of the core Microsoft suite offerings (Word, PowerPoint, Excel). * Excellent communication and outstanding customer service and listing skills. * Basic keyboarding skills * Ability to analyze and interpret data * Critical thinking, sound judgment and strong problem-solving skills essential * Team oriented, open minded, flexible, and willing to learn * Strong attention to detail and accuracy required * Ability to prioritize and function effectively, efficiently, and accurately in a multi-tasking complex, fast paced and challenging department. * Ability to follow oral and written instructions and established procedures * Ability to function independently and manage own time and work tasks * Ability to maintain accuracy and consistency * Ability to maintain confidentiality Preferred Job Qualifications: * Associates Degree in Accounting or Business Administration * Working knowledge of medical terminology and anatomy and physiology is preferable. Physical Demands: Competencies: Disclaimer: The above is intended to describe the general content of and requirements for the performance of this job. It is not to be construed as an exhaustive statement of duties, responsibilities or requirements. Responsibilities: Provides on-going monitoring to compile and track performance at the team and individual level and provides trend data to the management team. Prepares and analyzes internal and external quality reports for management staff to review - High dollar accounts; Aged accounts; Guarantor change account; CEA report; Claim edits; DNB accounts. Works newborn accounts - monitoring the addition of insurance for newborn coverage. 3. Reviews prior account notes for past due balances and any information that might aid in the account resolution process, as well as documents all encounters and actions. Follows up with responsible person managing account for updates to resolution. 4. Monitors daily Metrics dashboard for additional accounts that will impact overall increase in unresolved accounts that would impact department's dashboard metrics for DNFB, Claim edits, and CFB Days. 7. Exercise exceptional customer service skills when communicating with our team members, as well as our internal customers. Finds resolution within the phone interaction satisfactory to the caller and/or having the knowledge when to escalate to their supervisor. 8. Interacts and collaborates with numerous departments to resolve issues while also analyzing necessary information that will ensure hospital reimbursement. Initiates requests for financial Rush University Medical Center's Organizational Integrity Program, Standards of Conduct, as well as other policies and procedures to ensure adherence in a manner that reflects honest, ethical, and professional behavior. Guards to assure that HIPAA confidential medical information is protected. 9. Attends regular EPIC training sessions or other sessions conducted for the benefit of associates involved in the Financial Counseling functions at all levels. 10. Other duties as needed and assigned by the supervisor/manager. Rush is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, and other legally protected characteristics.
    $20.2-31.8 hourly 8d ago
  • Coding Quality review Specialist

    DLM 4.6company rating

    Remote quality improvement specialist job

    🕒 Job Type: Full-Time, Regular We're looking for a Coding Quality Review (CQR) Specialist to join our team! This is a remote/work-from-home position supporting our Coding Quality Review team. Your main role will be reviewing inpatient and outpatient medical coding to make sure it's accurate, consistent, and follows national and company guidelines. What You'll Do Lead and perform various coding quality reviews (routine, pre-bill, policy-driven, incentive-based). Ensure coders follow national guidelines and company policies. Use your expert knowledge of medical coding. Join special projects or reviews as needed. Maintain 95%+ productivity and 95%+ accuracy. Stay up to date on industry standards and coding guidelines. Complete all required training and education. Qualifications Education: Associate's or Bachelor's degree in HIM/HIT (preferred). Certifications: RHIA or RHIT required. Must be an Inpatient (IP) Coding Auditor for MS-DRG. Must have coding experience in all body systems (not just one specialty). Experience Required: 10+ years of hands-on medical coding experience. 3+ years of inpatient MS-DRG auditing in a hospital setting. Note: This role is not suitable for recent graduates-significant experience is essential.
    $47k-64k yearly est. 60d+ ago
  • Coordinator II, Performance Monitoring

    Cardinal Health 4.4company rating

    Remote quality improvement specialist job

    Cardinal Health Sonexus Access and Patient Support helps specialty pharmaceutical manufacturers remove barriers to care so that patients can access, afford and remain on the therapy they need for a better quality of life. Our diverse expertise in pharma, payer and hub services allows us to deliver best-in-class solutions-driving brand and patient markers of success. We're continuously integrating advanced and emerging technologies to streamline patient onboarding, qualification and adherence. Our non-commercial specialty pharmacy is centralized at our custom-designed facility outside of Dallas, Texas, empowering manufacturers to rethink the reach and impact of their products. **Together, we can get life-changing therapies to patients who need them-faster.** **What Performance Monitoring contributes to Cardinal Health:** Performance Monitoring is responsible for establishing, maintaining and enhancing customer business through contract administration, customer orders, and problem resolution. Performance Monitoring is responsible for monitoring, analyzing and reviewing customer contact quality. **Responsibilities:** + Conduct quality reviews of Adverse Events submitted by staff before submission to client safety unit. + Conduct case audits to ensure correct process steps have been followed for the "patient journey" + Monitor calls and provide effective written feedback + Maintain knowledge of the client's program and product/service offerings. + Interpret and transcribe inbound and outbound calls from patients and health care providers. + Identify adverse events when monitoring calls. + Ensure documentation is in order following client regulatory guidelines. + Identify trends and training needs from call monitoring and escalate appropriately. + Work effectively with dynamic, integrated task teams + Maintain a work pace appropriate to the workload **Qualifications** + HS Diploma, GED or technical certification in related field or equivalent experience, preferred. + 2 years' call center or transcriptionist experience preferred. Certified Medical Transcriptionist (CMT) qualification would be an asset. + 2 years' quality review experience preferred. + Knowledge of medical terminology preferred. + Exceptional listening skills required. + Proficient in Microsoft Office (Excel, Word, PowerPoint, etc.) + Multi-tasking, time management and prioritization skills considered an asset. + Bilingual Spanish would be an asset. **What is expected of you and others at this level** + Applies acquired job skills and company policies and procedures to complete standard tasks + Works on routine assignments that require basic problem resolution + Refers to policies and past practices for guidance + Receives general direction on standard work; receives detailed instruction on new assignments + Refers to policies and past practices for guidance + Receives general direction on standard work; receives detailed instruction on new assignments + Consults with supervisor or senior peers on complex and unusual problems **Training and Work Schedules** : Your new hire training will take place 8:00am-5:00pm CST, mandatory attendance is required. This position is full-time (8-hour shifts, 40 hours/week). Employees are required to have flexibility to work any of our shift schedules during our normal business hours of Monday-Friday, 7:00am- 8:00pm CST. **Remote Details:** You will work remotely, full-time. It will require a dedicated, quiet, private, distraction free environment with access to high-speed internet. We will provide you with the computer, technology and equipment needed to successfully perform your job. You will be responsible for providing high-speed internet. Internet requirements include the following: + Maintain a secure, high-speed, broadband internet connection (DSL, Cable, or Fiber) at the remote location. Dial-up, satellite, WIFI, Cellular connections are NOT acceptable. + Download speed of 15Mbps (megabyte per second) + Upload speed of 5Mbps (megabyte per second) + Ping Rate Maximum of 30ms (milliseconds) + Hardwired to the router + Surge protector with Network Line Protection for CAH issued equipment **Anticipated hourly range:** $18.35 per hour - $26.40 per hour **Bonus eligible:** No **Benefits:** Cardinal Health offers a wide variety of benefits and programs to support health and well-being. + Medical, dental and vision coverage + Paid time off plan + Health savings account (HSA) + 401k savings plan + Access to wages before pay day with my FlexPay + Flexible spending accounts (FSAs) + Short- and long-term disability coverage + Work-Life resources + Paid parental leave + Healthy lifestyle programs **Application window anticipated to close:** 1/2/2026. If interested in opportunity, please submit application as soon as possible. The hourly range listed is an estimate. Pay at Cardinal Health is determined by multiple factors including, but not limited to, a candidate's geographical location, relevant education, experience and skills and an evaluation of internal pay equity. _Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply._ _Cardinal Health supports an inclusive workplace that values diversity of thought, experience and background. We celebrate the power of our differences to create better solutions for our customers by ensuring employees can be their authentic selves each day. Cardinal Health is an Equal_ _Opportunity/Affirmative_ _Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, ancestry, age, physical or mental disability, sex, sexual orientation, gender identity/expression, pregnancy, veteran status, marital status, creed, status with regard to public assistance, genetic status or any other status protected by federal, state or local law._ _To read and review this privacy notice click_ here (***************************************************************************************************************************
    $18.4-26.4 hourly 2d ago

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