Cedars-Sinai Manager (Registered Nurse) - MN Quality & Patient Safety in Beverly Hills, California
Would you like to be part of an organization that is committed to delivering the highest quality of medical care to our patients? Do you have a passion for using your nursing skills and leadership abilities in a state-of-the-art clinical environment? Then please consider applying for this full-time leadership role. We would be happy to hear from you!
Cedars Sinai Medical Care Foundation is a Medical Group that has 63 practice medical offices located throughout Los Angeles and growing. There are 636 health care providers, specializing in Qualified Audiologist, Obstetrics/Gynecology, Rheumatology, Internal Medicine, Nephrology, Hematology/Oncology, Endocrinology, General Surgery, Ophthalmology, Hospitalist and more. Medical taxonomies which are covered include Hospice and Palliative Medicine, Otolaryngology/Facial Plastic Surgery, Registered Nurse, Gynecology, Vascular & Interventional Radiology, Surgery, Clinical, Nuclear Radiology, Psychiatry, Neurology and many more.
The Manager, MN Quality & Patient Safety is responsible for providing leadership by managing, developing, and implementing systems and processes for the following programs throughout the Cedars-Sinai Medical Care Foundation (CSMCF) and its Affiliates: patient complaints and grievances (also known as Voice of the Customer), health plan site audits, peer review, occurrence reporting, and quality case reviews. The Manager participates in the continuous readiness program for health plan audits and contributes to the execution of the CSMCF Quality Plan. Collaborates with physician and administrative leaders, and Quality department staff to proactively develop quality and safety indicators derived from grievance, occurrence reporting, peer review, and quality case review data.
Summary of Essential Duties:
Participates in and oversees staff supporting patient grievances, occurrences, risk reports, quality case reviews, and credentialing. Interfaces with CSMCF and Affiliate medical leadership responsible for triaging issues through a quality management review process.
Manages and participates in focus quality case reviews to identify root cause of care and system gaps. Utilize expert clinical knowledge and experience to collaborate with the QI Coordinators, Chief Medical Officer, and Medical Directors during quality case reviews.
Responds to adverse events and patient grievances as needed. Track, trend and monitor status of cases to ensure accurate and timely resolution of cases. Conducts thorough investigations, develops plans of corrective action plans as needed, and monitors cases and trends to ensure continuous quality and safety improvement.
Meets all health plan and regulatory requirements related to delegation, certification and licensing survey activities. Develops and is accountable for submission of the yearly quality management plan and other reports to health plans. Adheres to the organization’s Code of Ethics and Corporate Compliance Program. Complies with all relevant policies, procedures, guidelines, and all other regulatory and accreditation standards.
Assists in the development, review and revision of clinical policies and procedures, group and Foundation bylaws, rules and regulations, and is familiar with the professional services agreement (PSA) language related to medical staff requirements related to clinical quality improvement.
In conjunction with the Director, is responsible for the development, evaluation, implementation, and monitoring of QM programs and procedures; and for the integration of the QM Program across CSMCF and its Affiliates.
Assumes leadership role in CSMCF quality management audits and surveys. Ensures an infrastructure for continual readiness for external surveys. Responds to and coordinates communication and/or visits from Health Plans and other agencies.
Manages the Physician Peer Review Committee and Patient Safety Committee-related projects; Supports CSMCF’s Safety program by providing leadership and acting as a resource to Operational and Risk Management leadership. Is a resource for CSMCF Peer Review activities.
Build relationships and collaborate with key internal and external stakeholders to ensure timely completion of QM program-related tasks.
Subject matter expert on NCQA and other health plan accreditation, legal and regulatory standards for the medical network groups and affiliated physician practices.
Identify opportunities for sustained performance improvement based on quality strategic goals, organizational performance and evaluation of best practice opportunities.
Directly hires, supervises, manages, and provides leadership to clinical (RN) and non-clinical staff supporting grievances and complaints, peer review process, quality case reviews, health plan quality audits and/or health system standards.
Administratively supports Quality Management staff services by selecting, hiring, orienting and training, coaching and developing employees.
Facilitates organization-wide new employee orientation/training by representing the Quality Department in applicable areas.
Master’s degree preferred
- Current, unrestricted California RN license required
Five years of progressive and successful healthcare management and leadership.
Two or more years HMO/Managed Care experience is preferred.
Knowledge of health care regulations, accreditation, and licensing requirements preferred.
Two years prior training and experience utilizing process improvement principals based on Lean and Six Sigma methodology for streamlining and refining specific work process, preferred.
Cedars-Sinai is an EEO employer. Cedars-Sinai does not unlawfully discriminate on the basis of the race, religion, color, national origin, citizenship, ancestry, physical or mental disability, legally protected medical condition (cancer-related or genetic characteristics or any genetic information), marital status, sex, gender, sexual orientation, gender identity, gender expression, pregnancy, age (40 or older), military and/or veteran status or any other basis protected by federal or state law.