Quality Improvement RN

Location: Camarillo, CA
Date Posted: 02-01-2019
Quality Improvement RN – Managed Care
Camarillo, CA
** These roles are available as Contract, Contract-To-Hire, or Permanent, depending on what YOU are looking for! **
Quality Improvement Nurse Job Summary:
  • Lead the investigation, processing, and reporting of all identified potential quality issues (PQIs) following the Plan's procedures and timelines.
  • Track and trend PQI outcomes for the purpose of QI reporting and prioritization of actions/interventions.
  • Maintain the PQI database.
  • Annually review and edit PQI policies and procedures per APL updates and/or required process changes.
  • Conduct facility site reviews (FSR) according to DHCS site survey requirements, and maintain the FSR database.
  • Ensure that clinical and service PQI standards and FSR processes are compliant with state and federal requirements.
  • Participate in the annual HEDIS project, including medical record abstraction and over-reads to determine compliance with HEDIS measures and optimize performance outcomes.
  • Work closely with other departments of the Health Plan, the Ql staff, and Chief Medical Officer to achieve the goals of the QI department.
  • Participate in departmental quality improvement activities and audits, including but not limited to, performance improvement projects (PIPs) and CQI activities.
  • Lead, facilitate and/or participate in relevant committees and work groups; prepare reports, data or other materials for committee presentation.
  • Complete project-related communications, including job aides, member/physician mailings, business plans, graphical analyses, minutes and agendas.
  • Research best practices, national and regional benchmarks, and industry standards in order to help promulgate quality outcomes for the Plan.
Quality Improvement Nurse Background:
  • Current, valid, and unrestricted state Registered Nurse (R.N.).
  • Requires Bachelors of Science in Nursing (BSN) or related healthcare field; Master’s degree is a plus.
  • Certified Professional in Healthcare Quality (CPHQ) or certification in facility site reviews (FSR) is preferred.
  • Roughly 2 years acute care clinical nursing experience is required.
  • At least 3 years of experience in data analysis.
  • Around 5-7 years of experience in Quality Improvement, Risk Management, Compliance, and/or Accreditation demonstrating increasing responsibility in clinical quality improvement.
  • Direct experience with guidelines for Medicaid/Medicare and related state programs is required.
  • Knowledge of quality improvement / risk mitigation strategies in a managed care environment.
  • Analytical and problem solving acumen.
  • Knowledge of DHCS requirements, NCQA Accreditation standards, and HEDIS.
  • Excellent verbal and written communication skills and ability to interact in a positive manner within the medical/clinic community.
  • Computer skills to include Microsoft Word, Excel, database use, and basic data entry.
410.885.4745 (CALL – TEXT – FAX)

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