Care, Quality And Governance Coordinator Job at Cranstoun (Derby)

Licensed Nurse Care Coordinator Senior - Quality Management

An LVN/ LPN plays a crucial role in managing patient care and ensuring continuit...

Location

United States , Tyler

Salary:

Not provided

CHRISTUS Health

Expiration Date

Until further notice

Requirements

High School Diploma required
Minimum of 3 years of clinical or home health experience required
5 years supporting value-based care programs, accountable care organizations, or HEDIS
Knowledge of government programs (CMS), accountable care organizations (ACOs), HEDIS, and experience with payor cost sharing initiatives preferred
Knowledge of physician office practice operations and 3 years of experience in a physician practice is preferred
Proficiency in keyboarding and EHR systems, primarily Epic
LVN/ LPN in the state of employment and/or compact licensure required

Job Responsibility

Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders
Mentor, train and support the team of care coordinators, ensuring high-quality care and adherence to best practices. Assist with work assignments and development of new work processes as needed. Coordinate and assist with associate onboarding. Create education material for training
Monitor and ensure compliance with all regulatory requirements, organizational policies, standing delegated orders and protocols
Identify quality gaps and risk adjustment gaps. Participate in Quality Improvement Programs as indicated. Attend learning sessions and share information learned with team members. Assist in the development of tools, education, and workflow processes to assist the network in meeting CMS, ACO, documentation, and payor quality initiatives
Conducts internal review audits to facilitate feedback for documentation and efficiency of the care coordination team
Support Primary Care Providers and assist patients in scheduling preventative screenings and appropriate appointments. Maintain ongoing communication with healthcare providers through various tools and meetings
Monitor value-based care quality performance and pulls reports to identify open care gaps. Conducts telephonic outreach on behalf of providers to close care gaps & address medication adherence to facilitate star rating and quality performance
Providing counseling and health education to patients and families, using appropriate materials and standardized protocols. Serve as a subject matter expert in care transitions & quality metrics. Assist in educating practice staff on quality, payor, and government program requirements
Communicate resources and services available to patients through the continuum of care
Escalate health concerns to Primary Care providers and place referrals to appropriate care team members, i.e., Nurse Navigation, CHW, etc. Develop professional working relationships with ACO and CIN network providers, practice managers, and their staff to collaboratively manage follow-up care and improve overall health and wellness. Conduct in-person and virtual meetings with practice managers, staff, providers and managers to communicate program goals, results, and provide education

Fulltime

Intern Digital Marketing Governance and Market Care

Our team at the BMW Group is dedicated to driving system innovations and data-dr...

Location

Germany , Munich

Salary:

Not provided

BMW

Expiration Date

Until further notice

Requirements

Studies in business, marketing, communication or a related field
Strong affinity for the automotive industry
Advanced MS Office skills, especially Excel, Outlook and PowerPoint
Analytical and logical thinking, strong self-organization and communication skills
Hands-on mentality and proactive involvement in topics
Team player with flexibility and a high level of initiative
Fluent in English and German

Job Responsibility

Support the Governance & Market Care Team in areas such as Knowledge Management, Translation Management, Reverse Funnel Planning, and Data Privacy
Help to maintain and update our internal knowledge base, coordinate with external agencies, and drive knowledge migration forward
Assist in coordinating translation requests, handling quality inquiries, and supporting the maintenance of translation quality tools
Support with Excel tasks for Reverse Funnel Planning and Reporting
Help to prepare presentations and workshops for various committees and circles
Support the Digital Hub by contributing to sub-projects, such as the conception of workshops and documentation
Support the independent handling of tasks and receive regular feedback from your mentor

What we offer

Comprehensive mentoring & onboarding
Personal & professional development
Flexible working hours
Mobile work
Attractive & fair compensation
Apartments for students (subject to availability & only at the Munich location)

Fulltime

New

Patient Care Coordinator

We are looking for a detail-oriented individual to support patient access and fi...

Location

United States , Minneapolis

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Experience in healthcare revenue cycle operations, with emphasis on front-end financial clearance, pre-registration, or related patient access functions
Strong background in insurance verification, benefits review, prior authorization support, and interpretation of patient liability for healthcare services
Working knowledge of commercial insurance, Medicare, and Medicaid plans, including coverage rules, limitations, and coordination considerations
Proficiency with EMR or EHR platforms, with Epic experience required
Ability to perform effectively in fast-paced, productivity-focused settings while maintaining a high level of accuracy and attention to detail
Solid understanding of medical terminology, healthcare procedures, and billing-related workflows
Effective written and verbal communication skills, with the ability to explain financial information to patients in a clear and thorough manner

Job Responsibility

Conduct pre-registration conversations with patients to gather demographic, insurance, and service-related details, then enter complete and accurate information into Epic
Review active insurance coverage for scheduled visits or admissions by completing eligibility checks and documenting verification results in the appropriate system
Analyze plan benefits for upcoming services, including effective dates, limitations, authorization needs, and potential patient payment obligations
Prepare and communicate cost estimates so patients have a clear understanding of anticipated financial responsibility before care is delivered
Explain applicable patient-facing policies and required documentation, including treatment-related acknowledgments, general rights information, and other registration materials
Identify situations involving limited or insufficient coverage, discuss available assistance options, and connect patients with financial counseling or government support resources when appropriate
Provide guidance to newer team members by sharing knowledge related to payer requirements, revenue cycle processes, and issues that affect financial clearance outcomes
Support additional operational tasks as needed to help maintain workflow quality, productivity, and service standards in a high-volume environment

What we offer

Medical insurance
Vision insurance
Dental insurance
Life insurance
Disability insurance
401(k) plan

Fulltime

Licensed Nurse Care Coordinator - Population Health

An LVN/ LPN plays a crucial role in managing patient care and ensuring continuit...

Location

United States , Irving

Salary:

Not provided

CHRISTUS Health

Expiration Date

Until further notice

Requirements

High school diploma required
Minimum of 3 years of clinical or home health experience required
LVN/LPN in the state of employment and/or compact licensure required
Knowledge of government programs (CMS), accountable care organizations (ACOs), HEDIS, and experience with payor cost sharing initiatives preferred
Knowledge of physician office practice operations and one year of experience in physician practice preferred
Proficiency in keyboarding and EHR systems, primarily Epic.

Job Responsibility

Identify quality gaps and participate in Quality Improvement Programs as indicated
Support Primary Care Providers and assist patients in scheduling preventative screenings and appropriate appointments
Conduct telephonic outreach on behalf of providers to close care gaps & address medication adherence
Provide counseling and health education to patients and families
Serve as a subject matter expert in care transitions & quality metrics
Assist in educating practice staff on quality, payor, and government program requirements
Communicate resources and services available to patients through the continuum of care
Escalate health concerns to Primary Care providers and place referrals to appropriate care team members
Develop professional working relationships with ACO and CIN network providers
Document relevant, comprehensive information and data using standard assessment tools

Fulltime

Vice President, Client Care And Experience

Location

Canada

Salary:

170000.00 CAD / Year

Mirams Becker

Expiration Date

Until further notice

Requirements

Minimum of 10 years' related experience in progressive leadership roles, including at least five years of senior leadership experience within a community or health care environment
Master's degree in a regulated health or social service profession, education, or equivalent required
Current registrant in good standing with a recognized regulatory college, such as the College of Social Workers and Social Service Workers, College of Nurses of Ontario, College of Occupational Therapists of Ontario, or equivalent
Extensive knowledge of the social and health services field, including trends, community needs and issues, funding and grant sources, regulatory frameworks, and front-line service delivery systems
Knowledge of supportive housing, complex care, seniors' services, personal support services, mental health, substance use, and home care
Comprehensive knowledge of relevant legislation and regulatory requirements
Demonstrated experience supervising senior-level staff and building leadership capacity across complex teams
Strong ability to communicate, influence, and build alignment across multiple stakeholders, including clients, families, staff, partners, funders, government, and sector leaders
Proven ability to develop, direct, and evaluate service provision, including new models of care that respond to client, community, and organizational needs
Skilled in project and change management, with the ability to guide teams through evolving priorities, new initiatives, and service transformation

Job Responsibility

Operational leadership of client care across LOFT's supportive housing, specialized services, complex care, and home care portfolios
Ensure the delivery of safe, high-quality, person centred services that align with organizational priorities, best practices, and applicable regulatory and accreditation requirements
Translate LOFT's client care strategy into integrated operational execution, driving consistency, innovation, continuous improvement, and measurable outcomes across service lines
Strengthen coordinated care delivery, workforce readiness, service quality, risk preparedness, and system alignment across the organization
Strategic leadership, people leadership, innovation and continuous improvement, client and caregiver experience, resource management, service delivery standards, quality and professional practice oversight, operational risk management, emergency preparedness, and funder and stakeholder accountability
Provide leadership in advancing LOFT's client experience standards, strengthening service delivery audit and oversight processes, supporting budgeting and forecasting, and ensuring client care operations are positioned to meet emerging needs across health, housing, and social services environments

Clinical Quality Coordinator QOC RN - Hybrid

Responsible for quality functions for the health services business unit, which i...

Location

United States , Phoenix

Salary:

Not provided

Blue Cross Blue Shield of Arizona

Expiration Date

Until further notice

Requirements

2 years of experience in a clinical field of practice, health insurance, or other health care related field
Associate's Degree general field of study, or post high school nursing diploma
Active, current, and unrestricted license to practice in the State of Arizona as a Registered Nurse

Job Responsibility

Receive and document complaints received regarding potential quality of care concerns
Conduct clinical review of complaints received for quality of care concerns
Document and present cases to Medical Director for clinical review and decision
Track results of cases presented and outcomes of the clinical reviews
Review medical records as needed for quality of care and other corporate initiatives
Meet quality and timeliness standards to achieve individual and departmental performance goals as defined within the department guidelines
Consult and coordinate with various internal departments, external plans, providers, vendors, businesses and government agencies to obtain information to meet departmental projects and goals
Document and record facts in regards to inquiries, correspondences and projects by updating files and systems
Demonstrate and maintain current working knowledge of the required BCBSAZ systems, procedures, forms and manuals
Comply with all state and federal regulations for activities performed

Fulltime

Licensed Nurse Care Coordinator - Population Health

An LVN/ LPN plays a crucial role in managing patient care and ensuring continuit...

Location

United States , Irving

Salary:

Not provided

CHRISTUS Health

Expiration Date

Until further notice

Requirements

High school diploma required
Minimum of 3 years of clinical or home health experience required
LVN/LPN in the state of employment and/or compact licensure required
Knowledge of government programs (CMS), accountable care organizations (ACOs), HEDIS, and experience with payor cost sharing initiatives preferred
Knowledge of physician office practice operations and one year of experience in physician practice is preferred
Proficiency in keyboarding and EHR systems, primarily Epic

Job Responsibility

Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders
Identify quality gaps. Participate in Quality Improvement Programs as indicated
Support Primary Care Providers and assist patients in scheduling preventative screenings and appropriate appointments. Maintain ongoing communication with healthcare providers through various tools and meetings
Value-based care quality performance and pulls reports to identify open care gaps. Conducts telephonic outreach on behalf of providers to close care gaps & address medication adherence to facilitate star rating and quality performance
Providing counseling and health education to patients and families, using appropriate materials and standardized protocols. Serve as a subject matter expert in care transitions & quality metrics. Assist in educating practice staff on quality, payor, and government program requirements
Communicate resources and services available to patients through the continuum of care
Escalate health concerns to Primary Care providers and place referrals to appropriate care team members, i.e., Nurse Navigation, CHW, etc. Develop professional working relationships with ACO and CIN network providers, practice managers, and their staff to collaboratively manage follow-up care and improve overall health and wellness
Document relevant, comprehensive information and data using standard assessment tools. Maintain patient chart compliance through proper documentation and updated: preventative screenings, medical history, medication, and immunizations
Unburden primary care providers by placing approved orders for labs and other screenings as per the Standing Delegated orders
Perform Transition of Care calls on patients transitioning from an inpatient stay to home, or emergency department encounter to identify the need for a follow-up appointment, community resource needs, scheduling follow-up appointments, reviewing discharge instructions, and medications. Utilizing clinical judgment and problem-solving skills to coordinate appropriate care with physicians and Nurse Navigation

Fulltime

Licensed Nurse Care Coordinator - Population Health

An LVN/ LPN plays a crucial role in managing patient care and ensuring continuit...

Location

United States , Irving

Salary:

Not provided

CHRISTUS Health

Expiration Date

Until further notice

Requirements

High school diploma required
Minimum of 3 years of clinical or home health experience required
Knowledge of government programs (CMS), accountable care organizations (ACOs), HEDIS, and experience with payor cost sharing initiatives preferred
Knowledge of physician office practice operations and one year of experience in physician practice is preferred
Proficiency in keyboarding and EHR systems, primarily Epic
LVN/LPN in the state of employment and/or compact licensure required

Job Responsibility

Identify quality gaps. Participate in Quality Improvement Programs as indicated
Support Primary Care Providers and assist patients in scheduling preventative screenings and appropriate appointments. Maintain ongoing communication with healthcare providers through various tools and meetings
Value-based care quality performance and pulls reports to identify open care gaps. Conducts telephonic outreach on behalf of providers to close care gaps & address medication adherence to facilitate star rating and quality performance
Providing counseling and health education to patients and families, using appropriate materials and standardized protocols. Serve as a subject matter expert in care transitions & quality metrics. Assist in educating practice staff on quality, payor, and government program requirements
Communicate resources and services available to patients through the continuum of care
Escalate health concerns to Primary Care providers and place referrals to appropriate care team members, i.e., Nurse Navigation, CHW, etc. Develop professional working relationships with ACO and CIN network providers, practice managers, and their staff to collaboratively manage follow-up care and improve overall health and wellness
Document relevant, comprehensive information and data using standard assessment tools. Maintain patient chart compliance through proper documentation and updated: preventative screenings, medical history, medication, and immunizations
Unburden primary care providers by placing approved orders for labs and other screenings as per the Standing Delegated orders
Perform Transition of Care calls on patients transitioning from an inpatient stay to home, or emergency department encounter to identify the need for a follow-up appointment, community resource needs, scheduling follow-up appointments, reviewing discharge instructions, and medications. Utilizing clinical judgment and problem-solving skills to coordinate appropriate care with physicians and Nurse Navigation
Must have exceptional oral communication skills, strong organizational skills, and ability to adapt to change

Fulltime

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Care, Quality And Governance Coordinator

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