Career Corner: Job Opportunities

Quality Improvement Nurse

Position: Quality Improvement Nurse Company: Humana Location: Tampa/Orlando/Daytona/South FL

Role Description:

Effectively develop, enhance and maintain provider clinical relationship across product lines. Deliver provider/member-specific metrics (e.g., SQR reports, Member on a page, Anvita alerts) and coach providers on gap closing opportunities for Humana members. Successfully promote practice-patients’ participation in clinical programs - providing information on participation, Clinical Program availability/descriptions and facilitating members with program engagement. Accurately define gaps in Humana’s service relationship with providers and facilitate resolution. Identify specific practice needs (e.g. use of most efficient interaction channel) to providing support. Review medical records and identify needed improvements that impact HEDIS measures or coding (i.e. identify deficiencies in data capture, use SQR to identify information and provide guidance to practice)Effectively coach provider office staff on best means to communicate with Senior members that may have hearing, vision, physical abilities challenges (i.e. Perfect Service orientation)

Role Necessities: Experienced clinical background as RN with Strong analytic skills and ability to use data to drive improvement activities, Previous utilization management, hospital or physician office practice experience, Previous experience and/or knowledge of Quality Improvement or process improvement, Strong knowledge of HEDIS/Stars/CMS/Quality.
Send resume to kfeldmann@humana.com

Job posted 1/31/2012

NATIONAL QUALITY IMPROVEMENT CONSULTANT

Health Research, Inc seeks a Quality Improvement Consultant to join a highly regarded team of public health professionals in the HIVQUAL-US program of the NYSDOH AIDS Institute. The consultant will provide ‘on-demand’ coaching and other TA services to Ryan White Program funded facilities (outside New York State) in the development of specific skills in performance measurement, quality improvement (QI), and quality management. The consultant will work to enhance QM/QI capacity in clinics in his/her portfolio with the ultimate goal of supporting improvement in quality of HIV care.

HRI is seeking a candidate with an advanced degree and relevant experience in developing, implementing, evaluating and overseeing of large-scale clinic, city and/or state-wide Quality Management (QM)/QM training programs. Experience in HIV/AIDS QM is preferred.

Applications will be considered on an ongoing basis. For priority consideration, please email CV and cover letter including hourly rate requirement and specific, relevant experience by Feb 29th, 2012.

Darryl W. Ng, Program Director, HIVQUAL
dwn01@health.state.ny.us

Posted: January 28, 2012

Comprehensive Clinical Development (CCD) formerly known as Comprehensive NeuroScience, Inc. (CNS) provides early phase pharmacology and specialty clinical trials. CCD plays a key role in advancing the development of innovative drugs and treatments for humans. With locations from coast to coast, CCD is a trusted provider to many of the world’s leading pharmaceutical companies, setting the highest standards in service, reliability and quality. Please visit our website at: www.comprehensivecd.com

Join our team of professionals in this exempt position.

QA Specialist (Miramar, FL & Tacoma, WA)

Job Description Summary:
The QA Specialist performs and manages the facilitation of compliance reviews and audits of internal systems, processes, clinical trial data, and functional areas as per department directives and annual goals.

Essential Functions:
* Supervises and performs routine and non-routine quality assurance audits to include: clinical investigator sites, vendors, processes and systems, study projects and document reviews.
* Facilitates sponsor and other third party audits, and regulatory inspections.
* Analyzes and evaluates available data and prepares written audit reports of findings and observations.
* Investigates compliance reports for major or significant quality events and reviews Corrective and Preventive (CAPA) plans.
* Serves as a Subject Matter Expert (SME) with respect to SOPs, applicable regulations, ICH Good Clinical Practices (ICH GCP), and relevant Good Regulated Practices (GXP).
* Tracks and manages all audit and other quality-related documentation.
* Assists with the oversight and administrative management of company-wide Standard Operating Procedures (SOPs).
* Assists in the development of strategies and policies for the quality management program.

Qualifications:
·         Education: Bachelor’s degree in life sciences, nursing or other relevant discipline.
·         Required Experience:
o   Minimum 4 years QA experience in clinical research industry, GCP-focused, and GLP preferred.
o   In-depth knowledge of U.S. Federal Regulations and Guidelines as well as international standards and guidelines for clinical trial conduct.
o   Familiarity and experience with validation requirements and Part 11 preferred. An equivalent combination of education and experience may be accepted as a satisfactory substitute for the specific education and experience listed above.
·         Certification/Licensure: None required.

Physical Demands:
· Routine standing, walking, sitting, keyboarding.
· Travel ~ 20-30% annually.
Send Resume to: Comprehensive Clinical Development at zlall@cnsmail.com

Posted on 1/22/2012

Registered Nurse

Munroe Regional Medical Center
Ocala, Florida

Munroe Regional Medical Center, located in Ocala, Florida, is Marion County's Most Preferred Hospital for Overall Quality & Image and Best Doctors & Nurses for nine consecutive years and a leader in cutting-edge medical care. We are currently seeking a Infection Control Practitioner to join us.

This position contributes to the mission of the Medical Center and the goals of the department by: Being responsible for medical record review and analysis for the purpose of data collection, facilitation of Medical Staff peer review and performance improvement process, and to meet regulatory agency requirements. Utilizes professional RN knowledge and clinical experience to assess and process quality of care issues. Provides reports of data to Medical Staff Departments and Committees, Patient Care Services and Risk. Verifies accuracy of hospital charges by identifying unbilled but documented and documented but unbilled services.

Requirements/qualifications include:

Registered Nurse in the State of Florida
ADN Areas of Specialization: Medical-Surgical/Critical Care
Minimum 5 years medical-surgical/critical care clinical experience with achievement of Clinical III or IV status or charge nurse role
Experience in quality review activities, preferred
Critical thinking and analysis, communication and presentation
Proficient in Windows 98, Word, Excel, and familiar with database principles

Besides our comprehensive benefits package, Munroe Regional is ideally located in Ocala, Florida, an area known for gently rolling hills, thoroughbred horse farms, crystal clear springs and a wealth of recreational activities, including mountain biking. Ocala also offers easy access to both coasts, as well as Tampa, Orlando and Jacksonville. We offer, relocation and transition assistance; and remember, Florida has no state income tax.

To apply, call Lorraine Davis, Nurse Recruiter at 352-402-5296, email your resume to lorrainedavis@mrhs.org, or visit www.MunroeRegional.com.

A smoke-free and drug-free workplace. Equal Opportunity Employer.

Posted: January 17, 2012

Clinical HEDIS Specialist

Health First Health Plans, Rockledge FL

The Clinical HEDIS Specialist is responsible and accountable for providing Uncompromised Safety, Superior quality, Memorable Patient/Customer Experiences, and Financial Stewardship by working closely with other departments to assure regulatory compliance and the overall success of the Quality Management (QM) Program for Health First Health Plans, Inc. (HFHP). The Clinical HEDIS Specialist will perform HEDIS chart retrieval, chart abstraction and review, data collection, integration of data, data quality review, and physician and office staff education. This position provides support to the QM team with data analysis with reports and intervention relative to clinical quality initiatives, as well as key quality and performance indicators.

Primary Accountabilities

This position is responsible for ongoing HEDIS data collection and improvement activities at the health plan and reports to the Supervisor of Quality and Accreditation.
Coordinates and performs onsite medical record reviews at targeted provider offices to determine the appropriate documentation, coding and billing practices, compliance with quality metrics, and compliance with service delivery and quality standards.
Maintains current knowledge of HEDIS technical specifications, and proficiency with the vendor’s reporting software to provide analytic support with data quality review and HEDIS reports.
Prepares confidential Member-specific service summary files of claims/encounter data history for review for approved outside entity (regulatory agencies).
Assists with implementing studies, audits, surveys, and with tracking, trending, and analysis of data for clinical and non-clinical QM activities.
Participates in QM readiness for regulatory agency audits, accreditation surveys, respond to RFPs and with preparation of reports, documents and binders.

Qualifications

Current, unrestricted RN license preferred, other clinical experience or other relevant quality improvement experience, HEDIS, and/or Health Plan experience may be considered.
Two or more years in managed care including Quality Management experience preferred.
Must have strong computer skills, including Word, Access, Excel, and an understanding of database management.
Knowledge base of clinical standards of care, preventive health standards, HEDIS, NCQA, governing and regulatory agency requirements, and the managed care industry.
Must have solid mathematical skills, and demonstrate accuracy in tabulation of data and calculation of rates based on defined numerators/denominators.
Ability to travel to physician offices; valid state-specific driver's license and reliable vehicle.
Ability to evaluate medical records with attention to detail.

Please apply at: www.health-first.org/careers.

Posted on 1/10/2012

Quality Assurance Specialist II-III

Job Description Summary:
The QA Specialist performs and manages the facilitation of compliance reviews and audits of internal systems, processes, clinical trial data, and functional areas as per department directives and annual goals.
Essential Functions:
• Supervises and performs routine and non-routine quality assurance audits to include: clinical investigator sites, vendors, processes and systems, study projects and document reviews
• Facilitates sponsor and other third party audits, and regulatory inspections
• Analyzes and evaluates available data and prepares written audit reports of findings and observations.
• Investigates compliance reports for major or significant quality events and reviews Corrective and Preventive (CAPA) plans
• Serves as a Subject Matter Expert (SME) with respect to SOPs, applicable regulations, ICH Good Clinical Practices (ICH GCP), and relevant Good Regulated Practices (GXP)
• Tracks and manages all audit and other quality-related documentation
• Assists with the oversight and administrative management of company-wide Standard Operating Procedures (SOPs)
• Assists in the development of strategies and policies for the quality management program

Qualifications:
• Education: Bachelor's degree in life sciences, nursing or other relevant discipline.
• Required Experience:
• Minimum 4 years QA experience in clinical research industry, GCP-focused, and GLP preferred.
• In-depth knowledge of U.S. Federal Regulations and Guidelines as well as international standards and guidelines for clinical trial conduct.
• Familiarity and experience with validation requirements and Part 11 preferred.
• An equivalent combination of education and experience may be accepted as a satisfactory substitute for the specific education and experience listed above.
• Certification/Licensure: None required.
• Knowledge, Skills, Abilities:
• Proficiency with existing and emerging regulatory requirement related to human clinical research.
• Well-developed analytical and problem-solving expertise.
• Multi-tasking ability and organizational skill.
• Excellent organizational, interpersonal and customer service skills.
• Proficiency in MS Office Suite (Word, Excel, PowerPoint).

Physical Demands:
• Routine standing, walking, sitting, keyboarding.
• Travel ~ 20-30% annually.

Work Environment:
• Predominantly office environment
• No direct reports

To Apply:

Please visit our website at: http://www.comprehensivecd.com

Send Resume to: Comprehensive Clinical Development; zlall@cnsmail.com

Posted 1/9/2012

To strengthen our motto to “Respond and Respect”, we believe every team member has the power to make a difference in the lives of others. As an organization focused on outstanding service, Bayfront Medical Center strives to ensure all aspects of the patient experience are well above expectations. Our combination of expert medical care, advanced technologies, and genuine commitment to treating our patients with warmth and respect ensure all the best patient outcomes and experiences. Our commitment to excellence extends through every aspect of our organization. Currently, our HIM Department is seeking an experienced:

Clinical Documentation Specialist

The primary responsibility of this role is to improve medical clinical documentation to substantiate medical necessity of services and facilitate accurate coding. Works collaboratively with Revenue Cycle (Health Information Management, Patient Financial Services, Patient Access Management), Case Management, Medical Staff Quality, Nursing, Providers, other allied health staff, and outside governmental and contractual agencies. Responsible for identifying opportunities in concurrent and retrospective inpatient clinical medical documentation to support quality, regulatory compliance, and effective coding. This individual acts as an effective change agent and educator for physicians and allied health staff. The position requires strong understanding of the requirements for clinical coding and billing according to the rules of Medicare, Medicaid, and commercial health plans along with knowledge of Interqual and medical necessity criteria. Serves as a resource for RN Case Managers and providers to assign the correct patient status and level of care and support the medical necessity of services.

The qualified candidate must have 5 years prior acute care hospital experience as clinician or inpatient coder or clinical documentation specialist. LPN, RHIT or CCS license/certification required. Bachelors degree in nursing or health information management preferred. Behind every patient success is the dedication of a unique team of skilled and talented individuals who help make Bayfront Medical the number one Trauma center in Pinellas County.
If you share our passion and customer service goals, we invite you to apply today: www.bayfront.org, eoe Become a fan: www.facebook.com/careersatbayfront eoe

Posted on 1/3/2012

Clinical Innovations Analyst

CarePlus Health Plans, Tampa, FL
Location: Tampa, FL

Uses information technology and manual reporting systems to track and compare organizational progress against performance goals; incorporates performance standards and benchmarks as the basis for performance measurement; uses reporting formats to identify significant variances from standard as the basis for managerial action. Proactively identifies, evaluates, and solves problems with rigorous logic and a systematic approach; looks beyond the obvious to see root cause issues and creative solutions.

Job Description:

Collect multi-faceted data, analyze the information and make recommendations which drive decision making.
Work with IT to enhance warehouse data content, define business areas for all clinical programs and develop new applications for more automated reporting.
Work with the clinical areas, including physician practices, to develop more automated reports for customer reporting and operational reporting.
Develop knowledge of Pharmacy and all clinical programs in order to support these areas through reporting.

Role Essentials: Degree in Business, Engineering, Math, Health Administration, Accounting or related field required. Prior experience working in a system analytics and/or data warehousing environment is required. Excellent organizational skills required. Excellent written and oral communication skills required. Excellent PC skills (including MS Word, Excel and Access) required. Excellent programming skills desired.Experience in business writing or creative writing desired. Experience in managed care or health care administration desired.Prior experience working with physician practice management systems desired.2-3 years’ experience in a HEDIS related field preferred.Certified medical billing coder desired.

To apply please send your resume to: vwerton@careplus-hp.com

Posted: January 2, 2012