Top Quality Management Executive - Healthcare jobs in Rhode Island
Top Quality Management Executive - Healthcare oversees all aspects of the quality management function for a hospital or other healthcare facility. Develops plans designed to improve the overall quality of the organization's facilities and patient care services. Being a Top Quality Management Executive - Healthcare oversees the implementation of quality improvement efforts designed to improve clinical performance and maintain compliance with the Joint Commission, HIPAA, and other accreditation standards. Responsible for planning and directing quality policies, programs, and initiatives. Additionally, Top Quality Management Executive - Healthcare requires a MD. Requires State License to Practice Medicine. Typically reports to Chief Executive Officer (CEO). The Top Quality Management Executive - Healthcare manages a business unit, division, or corporate function with major organizational impact. Establishes overall direction and strategic initiatives for the given major function or line of business. Has acquired the business acumen and leadership experience to become a top function or division head. (Copyright 2024 Salary.com)
Recently Added Top Quality Management Executive - Healthcare jobs
Healthcare Quality Mgmt Consultant
- Managed Staffing, Inc.
-
Woonsocket, RI
FULL_TIME
-
Description
Responsible for the review and evaluation of clinical information and documentation. Reviews documentation andinterprets data obtained from clinical records or systems to apply appropriate clinical criteria and policies in line withregulatory and accreditation requirements for member and/or provider issues. Independently coordinates the clinicalresolution with internal/external clinician support as required. Requires an RN with unrestricted active license- Reviews documentation and evaluates potential quality of care issues based on clinical policies and benefit determinations. Considers all documented system information as well as any additional records/data presented to develop a determination or recommendation. Data gathering requires navigation through multiple system applications. Staff may be required to contact the providers of record, vendors, or internal departments to obtain additional information.-Evaluates documentation/information to determine compliance with clinical policy, regulatory and accreditation guidelines.-Accurately applies review requirements to assure case is reviewed by a practitioner with clinical expertise for the issue at hand.-Commands a comprehensive knowledge of complex delegation arrangements, contracts ,clinical criteria, benefit plan structure, regulatory requirements, company policy and other processes which are required to support the review of the clinical documentation/information.-Pro-actively and consistently applies the regulatory and accreditation standards to assure that activities are reviewed and processed within guidelines.-Condenses complex information into a clear and precise clinical picture while working independently.-Reports audit or clinical findings to appropriate staff or others in order to ensure appropriate outcome and/or follow-up for improvement as indicated.
- Is this request for Peak Season? Select applicable value : _N/A - Not RAMP Related
- Duties : Reviews documentation and evaluates potential quality of care issues based on clinical policies and benefit determinations. Considers all documented system information as well as any additional records/data presented to develop a determination or recommendation. Data gathering requires navigation through multiple system applications. Staff may be required to contact the providers of record, vendors, or internal departments to obtain additional information.-Evaluates documentation/information to determine compliance with clinical policy, regulatory and accreditation guidelines.-Accurately applies review requirements to assure case is reviewed by a practitioner with clinical expertise for the issueat hand.-Commands a comprehensive knowledge of complex delegation arrangements, contracts ,clinical criteria, benefit plan structure, regulatory requirements, company policy and other processes which are required to support the review of the clinical documentation/information.-Pro-actively and consistently applies the regulatory and accreditation standards to assure that activities are reviewed and processed within guidelines.-Condenses complex information into a clear and precise clinical picture while working independently.-Reports audit or clinical findings to appropriate staff or others in order to ensure appropriate outcome and/or follow-up for improvement as indicated.
- Experience : 10 years of clinical experience required- Managed Care experience preferred
- Position Summary : Responsible for the review and evaluation of clinical information and documentation. Reviews documentation andinterprets data obtained from clinical records or systems to apply appropriate clinical criteria and policies in line withregulatory and accreditation requirements for member and/or provider issues. Independently coordinates the clinicalresolution with internal/external clinician support as required. Requires an RN with unrestricted active license
- Education : RN with current unrestricted state licensure
- What days & hours will the person work in this position? List training hours, if different. : M-F8-5
- Type of Start : Individual starts
- Program Office - Point Of Contact : Pedro Newberry
- Is this an in-person, patient-facing role? : Yes
- Onsite Requirements : Fully remote (never coming onsite)
Pperience?
No
Verifyable High School Diploma or GED Required
Yes Is this request for Peak Season? Select applicable value
_N/A - Not RAMP Related
Duties
Reviews documentation and evaluates potential quality of care issues based on clinical policies and benefit determinations. Considers all documented system information as well as any additional records/data presented to develop a determination or recommendation. Data gathering requires navigation through multiple system applications. Staff may be required to contact the providers of record, vendors, or internal departments to obtain additional information.-Evaluates documentation/information to determine compliance with clinical policy, regulatory and accreditation guidelines.-Accurately applies review requirements to assure case is reviewed by a practitioner with clinical expertise for the issueat hand.-Commands a comprehensive knowledge of complex delegation arrangements, contracts ,clinical criteria, benefit plan structure, regulatory requirements, company policy and other processes which are required to support the review of the clinical documentation/information.-Pro-actively and consistently applies the regulatory and accreditation standards to assure that activities are reviewed and processed within guidelines.-Condenses complex information into a clear and precise clinical picture while working independently.-Reports audit or clinical findings to appropriate staff or others in order to ensure appropriate outcome and/or follow-up for improvement as indicated.
Experience
10 years of clinical experience required- Managed Care experience preferred
Position Summary
Responsible for the review and evaluation of clinical information and documentation. Reviews documentation andinterprets data obtained from clinical records or systems to apply appropriate clinical criteria and policies in line withregulatory and accreditation requirements for member and/or provider issues. Independently coordinates the clinicalresolution with internal/external clinician support as required. Requires an RN with unrestricted active license
Education
RN with current unrestricted state licensure
What days & hours will the person work in this position? List training hours, if different.
M-F8-5
Type of Start
Individual starts
Program Office - Point Of Contact
Onsite Requirements
Fully remote (never coming onsite) - Reviews documentation and evaluates potential quality of care issues based on clinical policies and benefit determinations. Considers all documented system information as well as any additional records/data presented to develop a determination or recommendation. Data gathering requires navigation through multiple system applications. Staff may be required to contact the providers of record, vendors, or internal departments to obtain additional information.-Evaluates documentation/information to determine compliance with clinical policy, regulatory and accreditation guidelines.-Accurately applies review requirements to assure case is reviewed by a practitioner with clinical expertise for the issue at hand.-Commands a comprehensive knowledge of complex delegation arrangements, contracts ,clinical criteria, benefit plan structure, regulatory requirements, company policy and other processes which are required to support the review of the clinical documentation/information.-Pro-actively and consistently applies the regulatory and accreditation standards to assure that activities are reviewed and processed within guidelines.-Condenses complex information into a clear and precise clinical picture while working independently.-Reports audit or clinical findings to appropriate staff or others in order to ensure appropriate outcome and/or follow-up for improvement as indicated.
- 7 Days Ago
Program Manager - Healthcare Quality and Safety
- DVG TECH
-
Providence, RI
CONTRACTOR
- Position: Program Manager - Healthcare Quality and Safetylocation: Providence, RIContract: Long term Summary This position will work as a part of the RIDOH Center for Emergency Medical Service’s team ...
- 25 Days Ago
Quality Management Consultant
- Capleo Global
-
Woonsocket, RI
FULL_TIME
- Position Title: Quality Management ConsultantDuration: 03 Months with possibility of extensionLocation: RemoteShift hours: M-F 8-5Job DescriptionThe QM Consultant develops and implements data-driven s...
- 10 Days Ago
Quality Assurance Auditor - 1st Shift
- Tailored Management
-
North, RI
FULL_TIME
- Position DetailsExciting opportunity to join a multinational company that designs and builds electrical systems and provides services for the aerospace, defense, transportation and security markets!Jo...
- 2 Days Ago
Quality Management Nurse Abstractor TEMP
- Care New England
-
Providence, RI
FULL_TIME
- Job Summary: The Quality Management Nurse Abstractor reviews patient records, conducts concurrent and retrospective audits and abstracts clinical information required by the Center for Medicaid and Me...
- 1 Month Ago
Quality Inspector 2nd Shift
- Nelipak Healthcare Packaging
-
Cranston, RI
FULL_TIME
- We are looking for a 2nd Shift Quality Inspector. 2nd shift: 3:00pm to 11:00pm Nature of the Job: The Quality Inspector utilizes various inspection devices to measure product characteristics for confo...
- 1 Month Ago
Top Quality Management Executive - Healthcare jobs at Popular Companies
About Rhode Island
Rhode Island (/ˌroʊd -/ (listen)), officially the State of Rhode Island and Providence Plantations, is a state in the New England region of the United States. It is the smallest state in area, the seventh least populous, the second most densely populated, and it has the longest official name of any state. Rhode Island is bordered by Connecticut to the west, Massachusetts to the north and east, and the Atlantic Ocean to the south via Rhode Island Sound and Block Island Sound. It also shares a small maritime border with New York. Providence is the state capital and most populous city in Rhode Is...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Top Quality Management Executive - Healthcare jobs
$420,503 to $608,633
Most Popular Cities in Rhode Island for Top Quality Management Executive - Healthcare Jobs
What does a Top Quality Management Executive - Healthcare do?
Top Quality Management Executive - Healthcare in Florence, AL
“The healthcare management field plays a vital role in providing high-quality care to the people in our communities, which makes having a standard of excellence promoted by a professional organization critically important,” says Deborah.
December 16, 2019
Top Quality Management Executive - Healthcare in Petaluma, CA
“By becoming an ACHE Fellow and earning the distinction of board certification, healthcare leaders demonstrate a commitment to excellence in serving their patients.”.
December 03, 2019