Quality Improvement RN – Managed Care
New York, NY (Queens)
Quality Improvement Nurse Job Summary:
Quality Improvement Nurse Background:
- Organizes, directs, and leads staff to establish quality improvement objectives; this position encompasses intimate familiarity with the key elements of the Company's strategic plan and requires a detailed understanding and use of the techniques of system design, reengineering, project management, quality improvement, outcomes measurement, and statistical analysis; acts independently as a representative for executive management.
- Perform under minimal supervision with accountability for specific goals and objectives; work with the department leadership and others to develop performance improvement targets for quality, service, and efficiency.
- Provide leadership and implement changes targeted at systems improvement; measure and evaluate results.
- Establish quality metrics, assess quality outcomes, develop and implement quality improvement strategies; support the accomplishment of strategic plans that achieve high impact and significant improvements in organizational performance.
- Apply, teach, and skillfully use techniques for system design, reengineering, outcomes measurement and statistical analysis; assure that improvement activities are documented and reported within the organization and externally as appropriate.
- Build and reach consensus with leadership concerning identified problem areas and purses recommended solutions to increase growth and to improve productivity; provide input on budgeting, controlling costs, planning, scheduling, and procedural change to achieve and maintain an efficient, cost-effective program; act as a change agent and coach to instill and sustain changes.
- Demonstrate problem solving, leadership, conflict management, and team building skills to ensure a productive work environment and achievement of goals; manage conflict at many levels of the organization; effectively lead cross functional process improvement teams; mentor and advise management on the formulation and implementation of process improvement plans.
- Identify opportunities to improve processes; drive workforce productivity and cost savings for the business; track, analyze and evaluate key performance indicators (KPI) and service levels; perform root cause analysis and identify potential solutions; coordinate the efforts to audit providers and their provision of contractual benefits (e.g., smoking cessation, diabetic teaching).
Quality Improvement Nurse Benefits:
- Current, valid, and unrestricted state Registered Nurse (R.N) license.
- Certified Professional in Healthcare Quality (CPHQ) or similar certification is preferred.
- Bachelor of Science in Nursing (BSN) or related healthcare field is a plus.
- Requires 4-6 years related experience required, additional years preferred.
- Requires 4+ years experience designing and implementing business processes.
- Requires applicable systems/methods experience in Performance Improvement management, project life cycle management experience; ability to quickly understand processes using established methodologies and tools; flexibility to develop new approaches for specific situations.
- Around 2-4 years of recent experience in Quality Improvement or Quality Management at a health plan or other managed care organization (HMO/TPA/IPA/etc).
- Direct experience with guidelines for Medicaid/Medicare and related state programs is required.
- Computer skills to include Microsoft Word, Excel, database use, and advanced data analysis.
This established, nationally-recognized organization is a Fortune 500 company that is committed to the health and happiness of all their staff. They offer a comprehensive benefits package to all full-time, permanent employees including low cost health insurance plan, dental, vision, and life insurance. To assist employees in living a healthier life, they offer either on-site fitness center or discounts to local fitness centers and a comprehensive wellness programs. They also offer free or reimbursed parking, tuition assistance, matching 401(k), employee stock purchase plan, generous PTO plus paid holidays, and much more!