About The Role

Are you ready to bring your clinical competencies to a world-class Medical Group known for the very highest clinical standards? Do you have a passion for the highest quality and patient satisfaction? Then please respond to this dynamic opportunity available with one of the best places to work in Southern California! We would be happy to hear from you.

The Cedars-Sinai Medical Network is committed to helping primary care and specialist physicians provide excellent care to all their patients, who benefit from convenient access to primary and specialty care physicians and seamless coordination of care between them. As a part of Cedars-Sinai, our physicians and staff are partners in quality health care from a medical center that is consistently recognized as one of the finest hospitals in the country. For the 8th consecutive year, we have been named one of the top 20 Physician Groups in Southern California by Integrated Healthcare Associates (IHA).

Why work here?

Beyond outstanding benefits, competitive salaries and health and dental insurance we take pride in hiring the best, most passionate employees. Our talented staff reflects the culturally and ethnically diverse community we serve. They are proof of our dedication to creating a dynamic, inclusive environment that fuels innovation and the gold standard of patient care we strive for.

What will you be doing in this role?

The Manager, MN Quality & Patient Safety is responsible for providing dedicated day-to-day operational and clinical management for the organization's quality, patient safety, delegated oversight, and physician governance infrastructure for the Cedars-Sinai ambulatory enterprise, including Cedars-Sinai Medical Network and Huntington Health Physicians. Collaborates with physician and administrative leaders, and Quality department staff to proactively develop quality and safety indicators derived from grievance, occurrence reporting, peer review, and quality case review data.

Primary Duties and Responsibilities

Participates in and oversees staff supporting patient grievances, occurrences, risk reports, quality case reviews, and credentialing. Interfaces with medical leadership responsible for triaging issues through a quality management review process.
Manages and participates in focus quality case reviews to identify root cause of care and system gaps. Utilize expert clinical knowledge and experience to collaborate with the QI Coordinators, Chief Medical Officer, and Medical Directors during quality case reviews.
Responds to adverse events and patient grievances as needed. Analyze trends, recurrence, closure delays, and systemic barriers; recommend improvements to standard work, governance structure, reporting cadence, and operational workflows. Use performance improvement methods to support action planning, implementation tracking, sustainment, and measurement of corrective actions.
Meets all health plan and regulatory requirements related to delegation, certification and licensing survey activities. Develops and is accountable for submission of the yearly quality management plan and other reports to health plans. Adheres to the organization’s Code of Ethics and Corporate Compliance Program. Complies with all relevant policies, procedures, guidelines, and all other regulatory and accreditation standards.
Assists in the development, review and revision of clinical policies and procedures, group and Foundation bylaws, rules and regulations, and is familiar with the professional services agreement (PSA) language related to medical staff requirements related to clinical quality improvement.
In conjunction with the Medical Director, Quality and Executive Director, is responsible for the development, evaluation, implementation, and monitoring of QM programs and procedures; and for the integration of the QM Program across CSMCF and its Affiliates.
Assumes leadership role in CSMCF quality management audits and surveys. Ensures an infrastructure for continual readiness for external surveys.
Manages the Physician Peer Review Committee and Patient Safety Committee-related projects; Supports CSMCF’s Safety program by providing leadership and acting as a resource to Operational and Risk Management leadership. Is a resource for CSMCF Peer Review activities.
Subject matter expert on NCQA and other health plan accreditation, legal and regulatory standards for the medical network groups and affiliated physician practices.
Identify opportunities for sustained performance improvement based on quality strategic goals, organizational performance and evaluation of best practice opportunities.
Directly hires, supervises, manages, and provides leadership to clinical (RN) and non-clinical staff supporting grievances and complaints, peer review process, quality case reviews, health plan quality audits and/or health system standards.
Facilitates organization-wide new employee orientation/training by representing the Quality Department in applicable areas.
Provide clinical oversight to RN quality coordinators who perform peer review case review and patient safety root cause analysis work. Validate the accuracy, clinical completeness, documentation quality, and escalation readiness of RN quality coordinator peer review case summaries and related safety-analysis materials.
Establish standard expectations for peer review case summaries, occurrence review documentation, RCA materials, evidence summaries, escalation thresholds, and closure documentation.
During high-volume months or periods of increased quality/safety case activity, directly perform quality case reviews to support timely case progression and closure.
This includes review of clinical quality cases, occurrence reports, peer review referrals, and selected patient safety/RCA materials requiring licensed nursing judgment, clinical critical thinking, and escalation assessment.
Delegate non-clinical supervisory responsibilities to the Quality Supervisor, including but not limited to routine work allocation, workflow monitoring, schedule/coverage coordination, onboarding support, administrative activities such as credentialing file tracking, outstanding item follow-up, packet preparation, status logs, documentation routing.
Provide cross-functional clinical expertise to other teams within the MNS Quality department.

Job qualifications

Education

Bachelor's Degree Healthcare or related field preferred
Master's Degree MPH, MBA, MHA preferred

Work Experience

6 years Progressive and successful healthcare management experience required
2 years HMO/Managed Care experience; Knowledge of health care regulations, accreditation, and licensing requirements, NCQA and HEDIS standards preferred
2 years prior training and experience utilizing process improvement principles based on lean and six sigma methodology for streamlining and refining specific work process