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Bunch CareSolutions, A Xerox Company , www.bunchcare.com, is a national medical management company based in Lakeland, Florida. We operate exclusively in the workers’ compensation industry as a full service, managed care firm. Since our founding in 1988, we have consistently grown in size, scope of services and standards of excellence. We have done so without compromising our clinical focus or our mission of “making the world a better place—one life at time.”
Using our clinical expertise, we offer innovative and customized managed care solutions focused on quality outcomes and medical cost containment. Because we are passionate and centered on providing programs built on our core competencies—medical case management and medical bill review—we have been highly successful in shortening claim duration, expediting medical recovery and improving financial and return-to-work outcomes for our clients and their injured employees.
We have an opening for a Director of Clinical Quality and Education.
Location: Remote
Travel: Less than 25%. Probably once per quarter for 1 week to Lakeland, FL office.
Position Overview:
The Director of Clinical Quality and Education is responsible for developing, training, implementing and maintaining quality assurance for Clinical Services. In addition, this position also is responsible for training and education for Clinical Services. This position, in conjunction with the National Medical Director and VP of Clinical Services, works to ensure that the highest levels of quality and outcomes are achieved.
Minimum Qualifications:
- Registered Nurse with strong clinical assessment, evaluation and implementation skills
- A current and unencumbered nursing license
- Bachelor’s Degree in Nursing or health-related field
- Minimum five (5) years management experience in Workers’ Compensation Case Management and Utilization Management
- Two years quality management experience in a URAC certified environment
- Familiarity with national and state medical treatment guidelines (ACOEM, ODG, etc.)
- Excellent oral, written and presentation communication skills
- Keyboarding skills and working knowledge of Microsoft Windows-based applications
- Understands state laws and guidelines as they apply to CM and UM activity
- Professional certification in Case Management (CCM, CRC, CRRN, COHN), Disability Management (CDMS) or Qualified Rehabilitation Provider (QRP)
- Ability to work within a changing environment and deliver changes to staff with a professional and positive approach
- Writing skills must be excellent with an ability to formulate data into training product
- Demonstrated organizational and planning skills
- Ability and willingness to travel
- Proven expertise in the development of training programs and documentation
- Excellent customer service skills
- Ability to communicate with diplomacy
- Demonstrated ability to work within a changing environment
- Demonstrated knowledge and understanding of business measurement and process improvement
Preferred Qualifications:
- Graduate degree in Nursing, Healthcare Administration, Business Administration, or other applicable related field.
- Three years experience in quality management
- Demonstrated knowledge of case management and utilization management
- Experience with California workers’ compensation for case management and utilization review
Primary Responsibilities:
- In conjunction with the National Medical Director and VP of Clinical Services, develop and implement utilization review standards to incorporate into our Quality Management Program, to include: .
a. Develop a system for ongoing clinical audits
b. Develop elements that are URAC compliant as well as jurisdictionally compliant
c. Develop quality reports that can be shared externally as well as any needed corrective action
- In conjunction with the National Medical Director and VP of Clinical Services, develop and implement Nurse First Response (NFR) standards to incorporate into our Quality Management Program, to include:
a. Develop elements of quality that can be measured
b. Develop a satisfaction survey process for consumers to ascertain their satisfaction with the service
c. Develop a process for determining outcomes of recorded calls
d. Develop quality reports that can be shared externally as well as any needed corrective action
- In conjunction with the National Medical Director and VP of Clinical Services, develop and implement Case Management standards to incorporate into our Quality Management Program, to include:
a. Develop elements that are URAC compliant, i.e. the CM audit tool URAC provided us
b. Develop quality reports that can be shared externally of the results as well as any needed corrective action
- Development of meaningful Clinical QIPs as determined by the QA outcomes to improve our quality as well as identify needs for technology solutions, training needs, etc. for Clinical Services staff
- Development of reports based on outcomes showing improvement or if no improvement, the barriers or education that was initiated as a result of no improvement. These reports will be used to:
a. communicate to our clients
b. be compliant with managed care initiatives, URAC and MA UR
c. communicate with our staff so they become more aware and cognizant of the quality initiatives
d. be able to award and reward staff for their efforts
- Supervise quality management and education personnel
- Identify needs for additional training and innovative ways to achieve it
- Identify barriers that can be solved with technology solutions to assist the nurses in productivity and quality
- Assistance with and active participation in the Quality Management Committee and clinical quality aspects of our managed care programs as jurisdictionally appropriate
- Working knowledge of client specific requirements for each client
- Ensure all training & training materials are consistent with Bunch corporate philosophy, Nursing policy and procedures and uphold URAC standards
- Promote consistency throughout the operation
Collateral Responsibilities:
- Demonstrate the ability to work in a team environment
- Lends expertise and participates in the education/training program
- Ensure the ongoing quality assurance activities of the organization are consistent with URAC standards as per specific client protocols.
Performance Expectations:
- All training is consistently presented in a positive and timely manner which emphasizes professionalism, quality and adherence to URAC standards as per specific client protocols.
- Performs QA on assigned files in timely & objective manner with goals met monthly
- Maintains professional rapport and effective communications with all customers and corporate divisions to support the goals of the organization; ensures collaboration and consensus building.
- Effectively implements strategic goals into operating plans and demonstrates and understanding of managed care, case management principles, industry specific knowledge and customer commitment.
- Demonstrates skill in leading and motivating individuals and teams to achievement. Coaches and develops staff effectively. Complies with corporate policies governing Human Resource management.
- Assures staff level competence and standards which effectively demonstrates to our customers expected results. Responsible to assure that the quality assurance program is reviewed, tools are effective, outcomes measured and appropriate plans of action are implemented and evaluated to achieve expected outcomes.
- Ensure the individualized training & evaluation programs to ensure consistent performance at or above the minimum quality performance standard of 90%
- Ensure Quality Management Committee standards and goals are met within the schedules prescribed
- Ensure policies meet appropriate state & jurisdictional standards and are in accordance with Bunch stated mission and philosophy.
- Ensure continuing education requirements are met by all staff in order to maintain current licenses and certifications
- Demonstrate highest professional standards of our discipline by maintaining all current professional licenses & certifications as well as pursuing further degrees, certifications & development
- In conjunction with the Human Resources Department, ensure that succession planning and individual professional development plans are in place for all positions at the supervisory and management levels within the QA department
Physical Demands and Work Environment:
- The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Physical demands: prolonged sitting; use hands to finger or handle objects or controls; occasionally reach with hands and arms; occasionally lift and/or move up to 15 pounds; talk; hear; prolonged viewing of computer monitor.
- Work environment: indoor office environment; minimal noise level.
(keywords: Nurse Continuing Education, Quality Improvement, Nurse Specialist, Performance Improvement Specialist, Clinical Quality Assurance, Medical Quality Assurance, Compliance Specialist, Clinical Quality Management Training, Clinical Project Leader)
Xerox is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, sex, marital status, sexual orientation, physical or mental disability, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by law. People with disabilities who need a reasonable accommodation to apply or compete for employment with Xerox may request such accommodation(s) by sending an e-mail to accommodations@xerox.com. Be sure to include your name, the job you are interested in, and the accommodation you are seeking.
**Job:** *Service Delivery Healthcare*
**Organization:** *Workmans Comp Site*
**Title:** *Director of Clinical Quality and Education (Remote)*
**Location:** *Florida-Orlando*
**Requisition ID:** *16005526*
**Virtual/work from home?** *Yes*