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Quality Improvement Manager - Total Quality Management

Company: Seton Family of Hospitals, TX
Location: Austin
Posted on: June 14, 2018

Job Description:

Job ID: 255154 Quality Improvement Manager - Total Quality Management Austin, Texas Regular / Day Additional Job Information Title:--RN-Utilization Review City, State:-- Austin,TX Location:-- Quarry Lake Department:---- Total Quality Management 001 Additional Job Details:----Full-Time,Day,--40 hours,Weekly About Us At Seton, we---re using the power of purpose to change healthcare--for the better. --As part of Ascension's Texas Ministry Market we do this through collaboration. Seton brings great minds and proven results from the across the nation together. From the best hires and strategic plans for growth, to the proactive connections we make within our community, we reach out to move ahead. Now, partnering with the University of Texas to build the new Dell Seton Medical Center, our future looks brighter than ever. We do this in force. With more than 12,800 associates, Seton is the leading healthcare service provider in Central Texas as well as its second largest employer. We serve an eleven county area of more than 1.8 million people. We have five urban acute care hospitals, two rural hospitals, a mental health hospital, three primary care clinics for the uninsured, and an increasing number of storefront care locations. We do this with vision. Since our founding in 1902, Seton has led the way in Austin --- expanding thoughtfully and with purpose; caring for our neighbors, because we know them so well. As a non-profit with a mission --- rather than a bottom line --- guiding us, improving health at a community level is our number one priority. Austin. It---s our home, and our heart. Located at the center of Texas hill country --- just a few hours from Dallas, Houston, and San Antonio --- Austin offers an appealing blend of hometown comfort and high-tech care. Whether you are looking for a vibrant nightlife and live music, recreational areas and activities, family-friendly fun, or educational offerings, Austin is a city that not only calls to you, but gently encourages you to sit down and stay awhile. With cultural diversity, a mild climate (and truly great outdoors), attractive and affordable housing options, and no state income tax, Austin is a feel-good choice for a rewarding way of life. The way we connect, the lives we affect. The Seton Healthcare Family is always looking for dedicated, talented professionals willing to share their hearts with those we serve. Being part of our close-knit team means performing to a higher standard. Embracing innovation, while understanding the importance of individual connections. And continually collaborating, learning and growing to realize new levels of personal and professional satisfaction. -- Job Description Job Summary: Provides health care services regarding admissions, case management, discharge planning and utilization review.--Leadership of Seton Health Plan---s (SHP) quality improvement and clinical informatics strategy; and achieving the annual goals established by the Health and Human Services Commission (HHSC) and/or internally for the Medicaid (STAR), Children---s Health Insurance Program (CHIP), Seton Employee Benefit Plan (EBP), and any other future lines of business.-- -- Responsibilities:

    Organizes and coordinates the activities and flow of work for the assigned program. Measures and reports program outcomes. Promotes the program to targeted customers. Participates in preparing the budget for the program. Develops, executes, and evaluates the plan wide quality improvement (QI) program. Leads and coordinates the activities of cross-functional teams across SHP and Seton Health Alliance, and achieves progressive improvement in clinical/health outcomes, service delivery, and the experience of care. Serves as subject matter expert on National Committee for Quality Assurance (NCQA) standards, regulatory requirements, techniques, and strategy. Designs, implements, and has oversight of the plan---s annual Healthcare Effectiveness Data and Information Set (HEDIS) data collection, analysis, and reporting efforts. Develops quality and clinical informatics strategy, statistical analysis plans, file formats, and report/programming specifications. Analyzes complex clinical, utilization, financial, and experience data from multiple sources (including delegated vendors) and produces reports, presentations, and recommendations. Serves as primary plan liaison with Seton Insurance Services (SIS) analytics and information technology departments, and enterprise quality and experience division. Advises SIS analytics and information technology departments on industry standards, protocols, applications, and strategy. Reviews admissions and service requests within assigned unit for prospective, concurrent and retrospective medical necessity and/or compliance with reimbursement policy criteria. Provides case management and/or consultation for complex cases. Assists departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals. Assesses and coordinates discharge planning needs with healthcare team members. May prepare statistical analysis and utilization review reports as necessary. Oversees and coordinates compliance to federally mandated and third party payer utilization management rules and regulations.
    Qualifications Licenses/Certifications/Registration:
    • Required Credential(s):
    • BLS Provider--credentialed from the--American Heart Association (AHA)--obtained within--3 Months (90 days)--of hire date or job transfer date.--
    • Licensed--Registered Nurse--credentialed from the--Texas Board of Nursing--.---- Education:
      • Diploma--
      • Bachelor's degree in a related field, or combination of High School degree and related experience required.
      • Bachelor's degree in a related field preferred. Work Experience:
        • 3 Years Preferred Technical Experience. Equal Employment Opportunity Seton Healthcare Family is an equal employment opportunity / Affirmative Action employer and complies with all applicable federal, state and local equal employment regulations and laws. It is the policy of the Seton Healthcare Family to afford equal employment opportunities to all employees and prospective employees without regard to their race, color, ancestry, religion, sex, sexual orientation, national origin, age, physical or mental disability, citizenship status, veteran status, gender identity or expression, or any other characteristic or status that is protected by federal, state, or local laws. This policy applies to all personnel actions, such as hiring, promotion, transfer, demotion, termination, layoff and all other conditions and privileges of employment in accordance with applicable federal, state, and local laws. Affirmative Action goes beyond the concept of equal employment opportunity. Affirmative Action policies and programs are required to overcome the present effects of past discrimination and to achieve equal employment opportunity for members of groups that are or have been formerly under-represented. Affirmative Action policies and programs are tools whereby additional efforts are made to recruit, employ and promote qualified members of formerly excluded groups, even if that exclusion cannot be traced to particular discriminatory actions. Through specific and result-oriented activities, Seton Healthcare Family---s goals are to ensure that every person is given full consideration through equal employment opportunity policies and practices and to achieve a representative workforce through its affirmative action efforts.-- It is further the policy of the Seton Healthcare Family to encourage vendors, contractors, affiliate institutions and others doing business with the Seton Healthcare Family to observe the principles of Equal Employment Opportunity and Affirmative Action. -- Seton Healthcare Family is an EEO/AA employer: M/F/Disabled/Vet. For further information regarding your EEO rights, click on the following link to the ---EEO is the Law--- poster: EEO is the Law Poster Supplement -- Please note that Ascension will make an offer of employment only to individuals who have applied for a position using our official application. Be on alert for possible fraudulent offers of employment. Ascension will not solicit money or banking information from applicants. Share: -->

          Keywords: Seton Family of Hospitals, TX, Austin, Quality Improvement Manager - Total Quality Management, Executive, Austin, Texas

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