QA \ UR \ Case Management Jobs


Quality Analyst Martinez, CA


Assists clinical support services and hospital ambulatory and health plan committees with patient care review and reporting requirements. Ensures accurate data collection, organization and tracking of medical staff departmental chart reviews, generation of computerized reports and maintenance of all data files.

Essential Functions:.
- Conducts concurrent and retrospective clinical studies by performing review using screening criteria as prescribed by the medical staff. Maintains confidentiality of all data.
- Performs variance screening and tracking by reviewing Clinical Pathway documentation to monitor quality of care issues.
- Enters QA/RM/UM variances from care paths, screening indicators, utilization focused studies and Medicare admission necessity and continued stay reviews into the department computer database.
- Aggregates data and refers all cases not meeting established criteria to Departmental Quality Assurance.
- Organizes and maintains the data to assure integrity and reliability for future reporting.
- Prepares statistical reports based on information retrieved from MIDAS, EZ-QA, PARRS, and/or CABS/ADT systems and manual record review and data aggregation. Enters unusual occurrence and other information into the department database.
- Creates and runs reports for departments and the Committees. Prepares worksheets, distributes charts, and completes applicable portions of the physician peer review forms and monitors their completion by the medical staff.
- Kaiser Permanente conducts compensation reviews of positions on a routine basis. At any time, Kaiser Permanente reserves the right to reevaluate and change job descriptions, or to change such positions from salaried to hourly pay status. Such changes are generally implemented only after notice is given to affected employees.


Basic Qualifications:
- N/A
- High School Diploma or General Education Development (GED) required.
License, Certification, Registration
- N/A

Additional Requirements:
- Must be able to work in a Labor/Management Partnership environment.

Preferred Qualifications:
- Six (6) monthsof experience within the last three (3) years as a quality analyst, or similar position, in health care preferred.
- Some college level courses preferred.
- Working knowledge of medical terminology preferred.
- Skills in medical record reading & review preferred. (Higher education can be substituted for experience.)

Primary Location: California,Martinez,Martinez Hacienda Medical Offices 200 Muir Rd.

Scheduled Hours (1-40): 0

Shift: Day

Working Days: Mon, Tue, Wed, Thu, Fri

Schedule: Call-in/On-Call

Job Type: Standard

Employee Status: Regular

Employee Group: Non-Union, Non-Exempt

Job Level: Individual Contributor

Job: QA / UR / Case Management

Public Department Name: Outpatient Quality

External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.

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