Company: Adecco Medical & Science
Location: Union City
Posted on: January 6, 2022
As an individual contributor, the position of Quality Review
Coordinator helps to ensure patient safety, quality and regulatory
compliance. This is accomplished through performing ongoing
assessments against Accreditation, Regulatory and Licensure
requirements. Researches and stays abreast of regulations and
statutes to determine the impact of implementation of new
regulations and statutes. Communicates required changes, develops
tools to assess compliance with meeting regulations and works with
existing workgroups to facilitate the required changes. Is
responsible for ensuring gaps are closed and improvement sustained.
Assessment and monitoring of quality of care and service related
activities including but not limited to peer review; site
assessments for all KFHP-CO ambulatory care and affiliated sites as
needed; investigation of quality of care complaints internally and
from external sources, i.e. the Quality Improvement Organization
(QIO) and other Federal/State monitoring agencies. Coordinates and
maintains activities related to ongoing practitioner performance
review and supports the Practitioner Peer Review Oversight
Committee. Coordinates and maintains clinical and service quality
improvement activity summaries for Center for Medicare and Medicaid
Services, NCQA and other regulatory oversight bodies. Proficient in
the platforms required to perform the functions of the position -
Metrs, Safety Connect, Peer Review Module, MSOW and Health Connect
(EPIC). Responsible for Survey Readiness for NCQA HP Accreditation,
Patient Center Medical Home, Ambulatory Surgery Centers, Sleep Lab,
CMS Special Needs Program, and CHP+ Programs. In addition, partner
with other support services for survey readiness for ACR, MQSA,
CLIA, MOHS and other areas in the organization that will adopt
regulatory standards without the formal
accreditation/certification. Involved in provider site visits
related to Quality of Care concerns and Facility Credentialing,
monitors Corrective Action Plans, and works with Clinical Quality
Oversight and leadership on communicating results. May be involved
with supporting the Quality Oversite Committee subcommittees and
other committee work as needed to ensure that KFHP-CO remains in
good standing with regulatory bodies. Assist managers and SMEs in
developing, revising policies and procedures to meet the regulatory
requirements. In addition to ad hoc project/work that is needed by
This position knows and complies with all Kaiser Permanente
quality, safety, and emergency policies and procedures.
Demonstrates quality and safety in every day work. Reports safety
hazards, accidents and incidents, and unsafe working conditions
Maintains and supports review activities of the CMS, Colorado
Foundation for Medical Care and State sponsored programs.
Coordinates (with Quality Review Physicians) peer review activities
associated with individual practitioners and affiliated
organizational providers, as well as assuring confidentiality of
peer review information, maintaining current and accurate data on
file for all peer review activities.
Responsible for obtaining the appropriate documentation and
updating the appropriate data repository for credentialing and
recredentialing of affiliated providers(i.e., Facilities ,
hospitals, nursing homes and free standing ambulatory surgical
centers); provides reports to appropriate staff/committee(s).
Collaborates with Contracting and the appropriate staff responsible
for ensuring that organizational providers are credentialed and
recredentialed according to meeting NCQA standards.
Develops and maintains policies and procedures on all review
Performs all Quality of Care reviews in the appropriate time frame
and follows a consistent process.
Consults and provides expertise in NCQA and other regulatory
oversight. Responsible for survey readiness including reporting and
keeping current on regulatory requirements. Develops site visit
criteria and performs site visits as appropriate. Facilitate the
development of corrective action plans as necessary and interacts
applicable departments to assure site visit compliance, i.e.,
infection control, facilities, laboratory and imaging.
Minimum three (3) years of experience in quality improvement in a
managed care environment.
Minimum three (3) years of nursing experience in a clinical
Bachelors degree in nursing required.Graduate of board approved RN
License, Certification, Registration
Registered Nurse License (Colorado)
Knowledge of study design principals (planning, measurement
selection, analysis and methodology), including intervention
strategies and methods and approaches for barrier analysis.
Ability to analyze and problem solve.
Possesses effective verbal, written, interpersonal and
Ability to interface effectively with clinicians.
Proficient computer skills and knowledge of Word, Access and Excel,
Experience with data base management and statistical process
control (control charting).
Familiarity of requirements for Local, State/Federal agencies,
nationally recognized accrediting bodies (NCQA, TJC, AAAHC, etc.)
and Quality Improvement Organizations.
Experience with Surveys.
Equal Opportunity Employer/Veterans/Disabled
To read our Candidate Privacy Information Statement, which explains
how we will use your information, please navigate to
The Company will consider qualified applicants with arrest and
Keywords: Adecco Medical & Science, Union City , Kaiser-Quality Coordinator, Other , Union City, California
Didn't find what you're looking for? Search again!