Fraud Prevention Manager jobs in Summerville, SC

In collaboration with leadership, physicians, and the Quality and Patient Safety Department, the Manager of Infection Prevention is responsible for the planning and execution of RSFH infection prevention programs, including the support of continuous excellence projects, adherence to quality reporting required by the government, and commercial entities and RSFH. The Manager of Infection Prevention functions as a a leader in Infection Prevention, project advisor; reporting on the status of projects, overseeing implementation and evaluation plans, and training project team members to use established quality improvement methods to maximize quality and efficiency. The Manager oversees the development of quality metrics for Infection Prevention and maintenance of institutional and external databases, as appropriate. This position prepares quality reports, scorecards, and presentations analyzes trends of performance metrics, identifies opportunities for improvement, and develops action plans in partnership with IPN/Ancillary Department leadership. This role serves as a liaison between clinicians and IT, working to develop and ensure appropriate use of computer/data systems for clinical decision support, and works collaboratively with other Quality divisions to ensure the coordination of high-quality, evidence-based care across the continuum and health system.

Minimum Qualifications:

Education: Master's Degree in Nursing or Healthcare required (such as NP, PA, Pharm D, MBA, MPH, MHA, MS).

Experience: At least five (5) years of Infection Prevention experience or five (5) years of work experience in health care or process improvement specific to Infection Prevention. Certification in Infection Control (CIC) required or must be obtained within 2 years of hire.

Licensure/Certification: If RN, must be currently licensed as a Registered Nurse in the state of South Carolina or holds a current compact multi-state license as a Registered Nurse in a recognized NCSBN Compact State and is not a permanent resident of SC. If NP, must be licensed as a Nurse Practitioner in the state of South Carolina. If PA or Pharmacist must be licensed and/or certified by appropriate agencies as required by state law. BLS or ACLS is required as determined by area of practice. Must provide copy of national certifications if applicable. Project management certification preferred.

Primary Source Verification (if applicable): If RN, NP, PA or Pharmacist - http://www.llr.state.sc.us/, If RN with current compact state/multi-state license - http://www.healthguideusa.org/nursing_license_lookup.htm

Knowledge/Skills: Requires strong analytical and critical thinking, a problem-solving skill to resolve complex clinical and systems issues. Ability to develop programs and operationalize them. Ability to plan and manage department personnel and resources. Must possess personal initiative, practical learning skills and conflict management. Excellent interpersonal, written, and oral communication skills. Experience in teaching and consulting. Ability to gather, organize, and analyze data, with strong skills in Excel spreadsheets, data management/database design and maintenance, and graphics to design and implement monitoring and evaluation tools which effectively communicate outcomes of care management efforts to diverse audiences. Works effectively in groups and ability to delegate and supervise other healthcare team members. Able to lead cross-functional teams without line authority.