System Manager, Virtually Integrated Care Operational Excellence Job at American Nursing Care (Englewood)

Clinical Specialist, Quality Management & Training

The Clinical Compliance & Quality Specialist is responsible for ensuring regulat...

Location

United States , California

Salary:

60600.00 - 91000.00 USD / Year

Personify Health

Expiration Date

Until further notice

Requirements

Holds an active unrestricted Registered Nursing License Required
May require additional licensure
Bachelor’s Degree preferred
3-5 years UR, CM, DM experience required
Managed care experience preferred
CPHQ and/or CCM certification preferred
3 years of experience leading, mentoring, and training staff, with a strong ability to teach diverse audiences and adapt methods to varying learning needs
Completed advanced coursework in teaching and/or mentoring
In-depth knowledge of state and federal regulations, including HIPAA, CMS, NCQA, and URAC
Ability to interpret and apply evidence-based guidelines and accreditation standards to clinical operations

Job Responsibility

Ensure compliance with state, federal, and accreditation standards, including ERISA, NCQA, URAC, and HIPAA
Conduct internal and external audits of clinical programs, prepare detailed reports, participate in case file preparation and mark-up for audits
Monitor clinical trial activities to ensure protocol adherence and regulatory alignment
Identify and manage risks related to clinical quality and compliance, review and approve Standard Operating Procedures (SOPs), and collaborate with cross-functional teams to resolve quality issues and implement improvements
Train clinical staff on regulatory requirements, quality standards, and department objectives
Develop and maintain evidence-based training materials and software tools, and deliver training in various modalities (classroom, virtual, self-learning, and one-on-one) to adult learners with different levels of experience
Track and report training activities and employee progress, updating department leadership on staff who are not meeting expectations
Participate in quality audit programs and conduct monthly sample quality analysis audits to identify gaps and training opportunities
Support corrective action plans as directed by management and provide comprehensive follow-up
Maintain current knowledge of industry regulations, accreditation standards, and evidence-based practices to support staff education

What we offer

Competitive base salary and benefits effective day one
Comprehensive medical and dental through our own health solutions (yes, we use what we build)
Unlimited PTO—rest and recharge time is non-negotiable
Mental health support, retirement planning, and financial protection
Professional development with clear career progression and learning budgets
Mission-driven culture where diverse perspectives drive real impact on people's health

Fulltime

Director Healthcare Operations

Location

Canada , New Brunswick

Salary:

Not provided

Foundever

Expiration Date

Until further notice

Requirements

Minimum 8-10 years of progressive experience in healthcare operations, health services administration or a related field
Minimum 3 years of leadership or supervisory experience managing teams
Demonstrated experience working within or alongside government health departments, public health agencies, provincial/territorial health authorities, or healthcare delivery organizations
Experience with virtual care, telehealth, or digital health programs is a strong asset
Background in contact centre, BPO, or service delivery operations within a healthcare context is an asset
Bachelor's Degree in Health Administration, Public Health, Business Administration, or a related field (required)
Relevant professional certifications (e.g., CPHIMS, LEAN/Six Sigma, PMP) are considered assets
Bilingualism in English and French is an asset
Healthcare Ecosystem Knowledge – Solid understanding of Canadian healthcare systems, government health program delivery, patient safety frameworks, and health service regulation
Client Relationship Management - Demonstrated success in building excellent customer/client relationships and government stakeholder relationships

Job Responsibility

Nurture client relationships by ensuring proactive delivery of solutions that enhance service quality and reduce costs
Foster a culture of patient safety through the development of policies, procedures, quality management, training, clinical systems and operational objectives
Oversee operating systems, policies and procedures within the Healthcare division for continual improvement aligned with business goals
Lead process improvement efforts within the vertical
Manage both human and material resources
Provide strong support for the long-term strategies of the organization
Be instrumental in translating the company’s vision into actionable strategies
Collaborate with senior leadership to define long-term goals and develop comprehensive plans to achieve them
Support Foundever and clients in achieving service, quality and contribution goals
Demonstrate sound fiscal management in achieving profitability goals

What we offer

Impactful work
Opportunity to work on cutting-edge AI technologies that will be game-changers for our business
Professional growth
Continuous learning and development opportunities in a dynamic, remote work environment
Competitive compensation
Attractive salary and benefits package
Collaborative environment
A supportive team culture with opportunities for occasional travel for training and industry events

Clinical Specialist, Quality Management I

Who We Are: Because health is personal. That's why Personify Health created the ...

Location

United States

Salary:

60600.00 - 91000.00 USD / Year

Personify Health

Expiration Date

Until further notice

Requirements

Active, unrestricted Registered Nurse (RN) license required
Basic computer literacy
The ability to work on multiple screens, and proficient typing skills
Proficiency in software applications including, but not limited to, Microsoft Word, Microsoft Excel, and Outlook
Ability to speak clearly and convey complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others
Ability to work independently and utilize written resources to problem solve
After training with our training department and 1.5 months ramp (3 months total), must have and be able to work in: Teams on and off camera, SharePoint, Drives as needed, VPN, UM Web or Health Notes, El Dorado, Quick Links, GIAS, ADP, Confluence, Phone system with headset, Smartsheet
Knowledge of medical claims and ICD-10, CPT, HCPCS coding
Excellent verbal and written communication skills for upward and downward conversations
Level I: In-depth knowledge of applicable regulations and accreditation standards (HIPAA, CMS requirements as applicable, NCQA, URAC)

Job Responsibility

Ensure compliance with state, federal, and accreditation requirements (e.g., HIPAA, CMS, NCQA, URAC, ERISA, as applicable)
Conduct internal and external audits of UM/CM/CDM processes and documentation
prepare audit files, findings, and corrective action recommendations
Identify quality and compliance risks and collaborate with cross-functional partners on mitigation and resolution
Review and support SOPs and workflows to ensure regulatory alignment and operational clarity
Support external audit readiness activities, including NCQA and URAC evidence preparation and maintenance
Develop, maintain, and deliver role-based training curriculum aligned to compliance standards, quality goals, and operational workflows
Conduct onboarding and orientation to prepare staff for assigned UM/CM/CDM functions
Deliver training using multiple modalities (virtual, self-paced, and one-on-one coaching) tailored to adult learners
Ensure training covers applicable processes such as case initiation and closure, documentation standards, high-dollar case monitoring, stop-loss notification, administrative support, customer service, and productivity expectations

What we offer

Competitive base salary and benefits effective day one
Comprehensive medical and dental through our own health solutions (yes, we use what we build)
Unlimited PTO—rest and recharge time is non-negotiable
Mental health support, retirement planning, and financial protection
Professional development with clear career progression and learning budgets
Mission-driven culture where diverse perspectives drive real impact on people's health

Fulltime

Clinical Specialist, Quality Management and Training

The Clinical Compliance & Quality Specialist is responsible for ensuring regulat...

Location

United States

Salary:

60600.00 - 91000.00 USD / Year

Personify Health

Expiration Date

Until further notice

Requirements

In-depth knowledge of state and federal regulations, including HIPAA, CMS, NCQA, and URAC
Ability to interpret and apply evidence-based guidelines and accreditation standards to clinical operations
Skilled in conducting internal and external audits of clinical programs
Proficient in case file preparation, SOP review, and audit mark-up
Capable of producing detailed audit reports and recommending corrective actions
Excellent analytical thinking and problem-solving abilities
Able to identify compliance risks and propose mitigation strategies
Uses written resources independently to resolve issues
Exceptional attention to detail in reviewing clinical documentation and audit trails
Maintains accurate records and ensures data integrity

Job Responsibility

Ensure compliance with state, federal, and accreditation standards, including ERISA, NCQA, URAC, and HIPAA
Conduct internal and external audits of clinical programs, prepare detailed reports, participate in case file preparation and mark-up for audits
Monitor clinical trial activities to ensure protocol adherence and regulatory alignment
Identify and manage risks related to clinical quality and compliance, review and approve Standard Operating Procedures (SOPs), and collaborate with cross-functional teams to resolve quality issues and implement improvements
Train clinical staff on regulatory requirements, quality standards, and department objectives
Develop and maintain evidence-based training materials and software tools, and deliver training in various modalities (classroom, virtual, self-learning, and one-on-one) to adult learners with different levels of experience
Training topics include case identification and creation, stop loss notification, administrative support, monitoring high-dollar cases, case closure, documentation, customer service excellence, and productivity expectations
Track and report training activities and employee progress, updating department leadership on staff who are not meeting expectations
Participate in quality audit programs and conduct monthly sample quality analysis audits to identify gaps and training opportunities
Support corrective action plans as directed by management and provide comprehensive follow-up

What we offer

Competitive base salary and benefits effective day one
Comprehensive medical and dental through our own health solutions
Unlimited PTO
Mental health support, retirement planning, and financial protection
Professional development with clear career progression and learning budgets
Mission-driven culture where diverse perspectives drive real impact on people's health

Fulltime

Infrastructure Senior Technical Analyst-Assistant Vice President

The Infrastructure Senior Technology Analyst is an intermediate level role respo...

Location

India , Chennai

Salary:

Not provided

Citi

Expiration Date

Until further notice

Requirements

8+ years of experience in Infrastructure Technologies delivery with a proven track record of operational process change and improvement
Ability to communicate technical concepts to non-technical audience
Ability to work with virtual and in-person teams, and work under pressure or to a deadline
Experience in a Financial Services or large complex and/or global environment preferred
Effective written and verbal communication skills
Effective analytic/diagnostic skills
MS Office Professional (All Flavours)
MS Outlook / Exchange
Various O/S Knowledge e.g. Windows 10, 11, MAC
Good Understanding of Networks/Connectivity including TCP/IP/DHCP/DNS/VPN

Job Responsibility

Create complex project plans, perform impact analyses solve/work high impact problems/projects, and provide resolutions to restore services
Drive Root Cause Analysis (RCA) post restoration of service
Design testing approaches, complex processes, reporting streams, and create automation of repetitive tasks
Review requirement documents, define hardware requirements and examine and update processes and procedures as necessary
Provide technical/strategic direction and act as advisor/coach to lower level analysts
Develop projects required for design of metrics, analytical tools, benchmarking activities and best practices
Responsible for overall operating system applications
Contribute to technical direction and strategic decisions
Has the ability to operate with a limited level of direct supervision
Can exercise independence of judgement and autonomy

Fulltime

Manager, HIM Data Integrity

Provides leadership, direction and oversight for the build, development and ongo...

Location

United States of America , Rochester

Salary:

70197.00 - 105295.00 USD / Year

University of Rochester

Expiration Date

Until further notice

Requirements

Bachelor's degree and 5 years of relevant experience in healthcare, security, access, privacy or HIM/EMPI management required
Or equivalent combination of education and experience
Experience coordinating or facilitating change management required
Experience with EMR master files and coordination of maintenance functions, RHIT/RHIA extensive HIM experience in a hospital or integrated system preferred
Experience with scanning systems preferred
Demonstrated analytical and critical thinking, problem solving, prioritization, and project management skills required
Attention to detail required
Effective written and verbal communication skills required
Microsoft office products (Excel, Power Point, Access, Word, Visio etc.) and virtual serves and integration required
Working knowledge of compliance and HIM framework, health care software, medical records management (eMPI), document or medical records management preferred

Job Responsibility

Provides leadership, direction and oversight for the build, development and ongoing maintenance of the assigned Health Information Management (HIM) applications, records and information within the enterprise electronic medical record (EMR) system and integrated electronic document management (EDM) system
Ensures the data integrity of the information (PHI) within the medical record and legal medical record (LMR), appropriate security and access, required regulatory documentation, and separation of duties in support of accurate, efficient and compliant processes related to EMR, patient access and revenue cycle activities
Provides direct leadership and organizational planning for the integral systems, processes and assigned staff that support this function
Oversees assigned staff that provide support to these systems and operational workflows
Provides direct leadership and planning of the organization to support these integral systems and processes
Manages assigned systems and applications from an Operational perspective
Analyzes, plans, and implements technology related initiatives and projects, including software updates, functionality enhancements, and system changes
Applies working knowledge of project management functions and techniques, develops project plans, and identifies dependencies, critical paths, risks, and mitigation
Prioritizes and schedules change requests, work assignments, and allocation of system and human resources
Translates operational needs into system requirements and terminology

Fulltime

Screening specialist inside sales

At Exact Sciences, we are cancer fighters. We are united by our mission to chang...

Location

United States , Madison

Salary:

42000.00 - 64000.00 USD / Year

Exact Sciences

Expiration Date

Until further notice

Requirements

Bachelor's degree Sales, Business Management, Marketing or, Science, or any other related field or 4 years relevant experience in lieu of degree
Proficiency in MS Excel, Word, Outlook and Customer Relationship Management (CRM) tool
Demonstrated ability to perform the essential duties of the position with or without accommodation
Legal authorization to work in the country of employment without current or future sponsorship

Job Responsibility

Activate healthcare providers, clinical professionals, and health system stakeholders by investigating leads, utilizing analytical insights and business opportunities to uncover potential new business
Generate deep insight into local healthcare ecosystems and market landscape to identify opportunities to enhance the system of care and deliver improved patient outcomes through integration of Exact Science’s solutions
Analyze the patient journey at various local systems of care to identify account opportunities and work with HCPs to improve clinical decision making and deliver better patient and population health outcomes in the context of EXAS future pipelines
Build a network of relationships, including clinical stakeholders and administrators, within accounts to gain insight into local healthcare systems’ priorities and unmet needs of clinicians and patients
Diligently catalogue customer insights and information via the Customer Relationship Management (CRM) database, including point of contact (POC) information, sales call activities, market intelligence, funnel development and other data points
Synthesize data from a range of formal and informal sources to understand the evolving and dynamic local care system, leveraging available tools and resources such as Engage (CRM), Excel, Tableau and available research to make data-driven decisions on account potential and opportunities to propel the customer along the sales continuum and drive utilization of Exact Sciences’ products
Work collaboratively with commercial team and cross functional partners to execute business imperatives and support customers’ education, resource needs and use of Exact Sciences’ products and solutions
Develop and implement business and account plans to increase the visibility and awareness of the Company’s products and maximize opportunities and sales growth
Create business and account plans based on strategic business goals and opportunities to drive use and acceptance of Cologuard and other Exact Sciences solutions to enhance clinical decision making and the effectiveness of the system of care
Implement business and customer plans to facilitate tailored customer engagements, which evaluate and address customer needs, and position Exact Sciences’ products and resources as a solution

What we offer

Paid time off (including days for vacation, holidays, volunteering, and personal time)
Paid leave for parents and caregivers
A retirement savings plan
Wellness support
Health benefits including medical, prescription drug, dental, and vision coverage
Relocation assistance available if needed
Access to amenities including a cafeteria, coffee shop, fitness center, and ergonomic workstations
Bonus eligible

Fulltime

Mobile In-Home RN

Registered Nurse (RN) – Mobile In-Home RN, Advocate Health Hospital at Home (Lut...

Location

United States , Park Ridge

Salary:

38.20 - 57.30 USD / Hour

Advocate Aurora Health

Expiration Date

Until further notice

Requirements

Completion of an accredited or approved program in nursing
Registered Nurse license issued by the state in which the team member practices
Basic Life Support (BLS) for Healthcare Providers certification issued by the American Heart Association (AHA)
Valid driver’s license issued by the Division of Motor Vehicles and acceptable vehicle operator record
Minimum of two-years of recent nursing experience in an acute bedside setting or emergency nursing
Proficiency in phlebotomy skills, IV insertion, and Midlines required
Proficient technology skills, use of electronic mail, electronic medical records systems, and remote patient monitoring equipment
Excellent communication (written and verbal), listening and interpersonal skills
Ability to work independently while in the patient’s home in collaboration with the virtual care team
Provides comprehensive nursing assessment in an untraditional nursing environment

Job Responsibility

Uses the nursing process to assess the needs of the patient, plan and implement individualized interventions in the home and evaluate the effectiveness of the plan of care
Includes the patient and family in planning and implementing care and develops and maintains a therapeutic relationship
Anticipates and recognizes significant changes in the patient’s condition, status, and need for care escalation
Provides in home assessment of the patient and takes appropriate actions when changes occur
Anticipates and alters the plan of care as needed, mobilizes appropriate resources, and collaborates with other health care team members
Implements strategies to reduce patient risk and increase patient safety while in the home
Actively coordinates the discharge plan utilizing an interdisciplinary approach
Applies evidence-based practice to deliver patient care in the home
Provides ongoing in-home evaluation of patient, team, and unit outcomes and is empowered to take appropriate action
Supports shared governance activities and initiatives to improve processes and patient outcomes

What we offer

Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program
Company vehicle and gas card provided

Fulltime

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System Manager, Virtually Integrated Care Operational Excellence

Job Responsibility

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