Quality Improvement Director - Healthcare jobs in Tampa, FL

Quality Improvement Director - Healthcare leads and directs process and overall quality improvement activities that produce better patient care and more efficient operations. Develops programs to review and evaluate patient care and outcomes. Being a Quality Improvement Director - Healthcare implements a strategy and plans for a quality improvement function within the facility in collaboration with the administrative and clinical leaders of the hospital. Tracks and presents results of improvement efforts and ongoing measures of clinical processes to management. Additionally, Quality Improvement Director - Healthcare requires a bachelor's degree. Typically reports to top management. The Quality Improvement Director - Healthcare typically manages through subordinate managers and professionals in larger groups of moderate complexity. Provides input to strategic decisions that affect the functional area of responsibility. May give input into developing the budget. Capable of resolving escalated issues arising from operations and requiring coordination with other departments. To be a Quality Improvement Director - Healthcare typically requires 3+ years of managerial experience. (Copyright 2024 Salary.com)

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Clinical Quality Improvement Specialist
  • Avalon Administrative Services, LLC dba Avalon Healthcare Solutions
  • Tampa, FL FULL_TIME
  • About the Company:

    Avalon Healthcare Solutions, headquartered in Tampa, Florida, is the world's first and only Lab Insights company, bringing together our proven Lab Benefit Management solutions, lab science expertise, digitized lab values, and proprietary analytics to help healthcare insurers proactively inform appropriate care, reduce costs, and improve clinical outcomes. Working with health plans across the country, the company covers more than 36 million lives and delivers 7-12% outpatient lab benefit savings. Avalon is pioneering a new era of value-driven care with its Lab Insights Platform that captures, digitizes, and analyzes lab results in real time to provide actionable insights for earlier disease detection, ensuring appropriate treatment protocols, and driving down overall cost.

    Studies show that 30% of clinical laboratory testing is unnecessary or overused. Inappropriate testing or missing a key screening can lead to complications and expense arising from unwarranted care, or not obtaining proper care when needed, leading to increased health risks and costs. Avalon helps ensure delivery of the right test, at the right time, and in the right setting. We seek to ensure the most effective patient treatment, improve clinical outcomes, and optimize cost and affordability.

    Avalon is a portfolio company of Francisco Partners, a global private equity firm that specializes in investments in technology and technology-enabled service companies.

    Avalon is a high growth company where every associate has an opportunity to make a difference. You will be part of a team that shapes a new market and business. Most importantly, you will help Avalon to achieve its mission and improve clinical outcomes and health care affordability for the people we serve.

    For more information about Avalon, please visit www.avalonhcs.com.

    Avalon Healthcare Solutions is proud to be an equal opportunity employer including disability/veteran. We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity or Veteran status.

    Avalon Healthcare Solutions provides and maintains a drug-free workplace for its employees.

    For more about Avalon, please visit our web site at http://www.avalonhcs.com.

    About the Clinical Quality Improvement Specialist Position (RTM):

    The Clinical Quality Improvement Specialist facilitates the establishment of QI activities and methods of measurement that are prioritized to organizational priorities. This position collaborates with various functional areas to understand and alleviate obstacles as needed and monitors for successful performance via the Quality Improvement Committee.

    This position is eligible for remote work, but quarterly travel to the corporate office in Tampa, Florida may be required.

    Clinical Quality Improvement Specialist - Essential Functions and Responsibilities:

    • Establish annual QI Work Plan document which defines quality improvement priorities from both an activity and metric standpoint; update to insert data and information as received; conduct annual evaluation.
    • Monitor required QI Work Plan metric trends, identify variation, convene functional area or cross-functional teams as needed to conduct root cause analysis and institute meaningful action to achieve defined performance goals.
    • Develop and monitor Policy Operations and Enforcement quality reports.
    • Policy Operations and Enforcement Data analytics.
    • Review QI and Utilization Management Program Description documents; identify and act on any need for revision identified.
    • Set agenda/create Quality Improvement Committee meeting materials to drive desired meeting outcomes and ensure proper recording of committee activities.
    • Perform various department functions and processes, such as those associated with client health plan delegation oversight, internal auditing functions, and annual QI/UM operational policy review and revision.
    • Manage and monitor clinical quality studies that may be undertaken by Avalon, to include receipt and analysis of trended data, assessment of national benchmarks as available, development of improvement recommendations (to include ROI and best practice interventions as appropriate), presentation to senior leadership, implementation of plan, and evaluation for desired result.
    • Perform quality auditing based on data analytics reporting with a keen eye for inconsistent results.
    • PRISM implementation/integration.
    • Other duties as assigned by Manager.

    Clinical Quality Improvement Specialist - Qualifications:

    • Bachelors Degree or equivalent work experience
    • 3-5 years of Health Care Quality Improvement experience in a managed care or health care services vendor relationship setting
    • Certified Billing and Coder
    • CPC (Certified Professional Coder) and/or CCS (Certified Coder Specialist), Certified Medical Auditor
    • Working knowledge of Medical Policies and clinical coding.
    • Strong knowledge of Health Plan claims, medical billing, and coding
    • Expert proficiency in written and oral communication skills required.
    • Expert proficiency in computer skills including Microsoft Office Suite products - Excel proficiency is a must.
    • Strong understanding of health insurance claims and terminology.
    • Strong communication, delivery, and presentation skills.
    • Strong understanding of laboratory billing and reimbursement practices.
    • High attention to detail and documentation.
    • Clinical experience with a background of ICD-10, CPT, and HCPCS coding principles.
    • Exceptional interpersonal skills with demonstrated ability to work independently as well as with a team.
    • Strong organizational skills.

    Clinical Quality Improvement Specialist - Preferred Qualifications:

    • Experience with Centers for Medicare & Medicaid Services (CMS) and industry standard billing, compliance, and reimbursement methodologies.
    • Lab/Genetic test experience/familiarity.
    • Familiarity with commercial payor medical policies
    • Experience working with proprietary developed programs.
    • Knowledge of and experience with laboratory medical coding rules and regulations, compliance, reimbursement, bundling issues.
    • Experience with data analysis tools (SQL, PowerBI, JIRA)
    • Experience with Agile/Scrum principles
    • Certification in Healthcare Quality
    • Biology, chemistry, medicine, nursing, medical technology, or related field of education

    PM18


    PI238493209

  • 2 Days Ago

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Clinical Quality Improvement Specialist
  • Avalon Administrative Services, LLC dba Avalon...
  • Tampa, FL FULL_TIME
  • About the Company: Avalon Healthcare Solutions, headquartered in Tampa, Florida, is the world's first and only Lab Insights company, bringing together our proven Lab Benefit Management solutions, lab ...
  • 2 Days Ago

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Quality Improvement Field Services Specialist
  • Sevita
  • Tampa, FL FULL_TIME
  • Explore Numerous Nearby Locations for Your Convenience!Schedule an Interview First - Apply Afterwards DISCOVER CAREERS, WELL LIVED. Our mission at Sevita is to create a world where every person has th...
  • 4 Days Ago

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Clinical Quality Consultant RN - Clinical Quality Improvement
  • Lakeland Regional Health
  • Lakeland, FL FULL_TIME
  • Position Information Work Type: Active - Benefit Eligible and Accrues Time Off Exempt: Yes Work Schedule: Monday - Friday Work Hours per Biweekly Pay Period: 80 Shift Time:0830-1700 (Flexible, rarely ...
  • Just Posted

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Director of Healthcare Operations (Hybrid)
  • VIPcare
  • Tampa, FL FULL_TIME
  • Our purpose is Better Health. Specializing in primary care for patients 65 is our passion.What’s Your Why?• Are you looking for a career opportunity that will help you grow personally and professional...
  • 2 Months Ago

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Nurse Reviewer - Remote
  • Healthcare Quality Strategies, Inc.
  • Tampa, FL FULL_TIME
  • NURSE REVIEWERS (RN) REMOTE WORK CANDIDATES MUST RESIDE IN FL PER DIEM: FLEXIBLE 20-30 HOURS PER WEEK Healthcare Quality Strategies, Inc. (HQSI), founded in 1982, is a small, vibrant not-for-profit or...
  • 6 Days Ago

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0 Quality Improvement Director - Healthcare jobs found in Tampa, FL area

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Remote Legal Account Executive
  • Examworks Group, Inc.
  • Tampa, FL
  • Overview: The Legal Account Executive identifies opportunities, seeks and engages new clients, develops new proposals an...
  • 3/28/2024 12:00:00 AM

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Dialysis Patient Care Technician
  • U.S. Renal Care, Inc.
  • Tampa, FL
  • Mission Diversity Inspiration Growth OUR MISSION At U.S. Renal Care, we're changing the lives of everyone living with ki...
  • 3/28/2024 12:00:00 AM

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Registered Nurse Home Health Private Duty
  • Maxim Healthcare Service
  • Riverview, FL
  • Maxim Healthcare Services is seeking a Registered Nurse (RN) to assume responsibility and accountability for the applica...
  • 3/27/2024 12:00:00 AM

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CENTCOM Threat Network Intelligence Analyst
  • CACI International, Inc.
  • Tampa, FL
  • CENTCOM Threat Network Intelligence Analyst Job Category: Intelligence Time Type: Full time Minimum Clearance Required t...
  • 3/27/2024 12:00:00 AM

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PATIENT FOOD SERVICES MANAGER II TRAVELING - Advent Health - Tampa, FL
  • Morrison Healthcare
  • Tampa, FL
  • **PATIENT FOOD SERVICES MANAGER II TRAVELING - Advent Health - Tampa, FL** **Tampa, Florida 33613** **Posted Date:** Jul...
  • 3/27/2024 12:00:00 AM

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Director of Sales and Business Development
  • Milliman
  • Tampa, FL
  • Who We Are TrendzData is an insurance technology practice within Milliman, Inc., one of the largest insurance consulting...
  • 3/26/2024 12:00:00 AM

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CENTCOM Threat Network Intelligence Analyst
  • CACI International
  • Tampa, FL
  • CENTCOM Threat Network Intelligence Analyst Job Category: Intelligence Time Type: Full time Minimum Clearance Required t...
  • 3/25/2024 12:00:00 AM

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Sensitive Support Operations SME
  • Lukos LLC
  • Tampa, FL
  • Sensitive Support Operations SME Minimum Qualifications Summary Certification & Education Bachelor's degree in relevant ...
  • 3/24/2024 12:00:00 AM

Tampa is a major city in, and the county seat of, Hillsborough County, Florida, United States. It is on the west coast of Florida on Tampa Bay, near the Gulf of Mexico, and is the largest city in the Tampa Bay Area. The bay's port is the largest in the state, near downtown's Channel District. Bayshore Boulevard runs along the bay, and is east of the historic Hyde Park neighborhood. Today, Tampa is part of the metropolitan area most commonly referred to as the "Tampa Bay Area". For U.S. Census purposes, Tampa is part of the Tampa-St. Petersburg-Clearwater, Florida Metropolitan Statistical Area....
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Quality Improvement Director - Healthcare jobs
$107,778 to $146,723
Tampa, Florida area prices
were up 1.1% from a year ago

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