Quality Management Director - Healthcare jobs in Bakersfield, CA

***This position is remote within California.

The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health’s Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups hospitals health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first.

Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art flexible Health & Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options including medical dental and vision plans for the employee and their dependents Health Spending Account (HSA) Life Insurance and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave.

***This position is remote within California.

Position Summary:

The Quality Management (QM) Coordinator will be a part of the Quality Management department. The Risk Management and Quality Improvement department works to measure and improve clinical quality functions across the enterprise. Under the direction of the Manager of Quality Administration, the Quality Management Coordinator will assist in the promotion of QM activities related to monitoring, assessing, and improving performance in health care delivery and services to plan members. Duties will include data collection, data entry, record maintenance, chart audits, member mailings, committee facilitation, collaboration with other departments, and interaction with contracted health plans. This position will also assist in the coordination, processing, and resolution of incoming member appeals and grievances. This position will work closely with Account Management Unit Claims and Utilization Management.  The Quality Management Coordinator actively participates in Quality Management activities and teams to improve documentation retrieval, outcomes, and compliance with database measures.

Minimum Qualifications:

- Two (2) or more years experience in an administrative position. Experience in creating and manipulating data with spreadsheets and/or databases using Excel Access or other similar programs and/or applications.
- Knowledge of current CPT ICD-10 and HCPCS coding procedures and practices.
- Extensive knowledge of Microsoft Office applications; Excel Word Outlook PowerPoint.

Preferred Qualifications:

- Experience in medical billing/coding medical documentation improvement pay-for-performance or similar programs preferred.
- Associates degree or a clinical Certification such as medical assistant (MA) preferred.
- Experience working with physicians offices in regards to coding documentation or quality measures preferred.
- Statistical analysis and database skills a plus.
- Awareness of clinical HEDIS measures.
- Ability to learn and use other software such as QNXT NextGen and other electronic medical records. Ability to navigate through patient information in an Electronic Medical Record (EMR) or a paper medical record.