Quality Improvement RN
• Manages and monitors quality improvement initiatives including, but not limited to, development and implementation of preventive health and chronic disease outcome improvement interventions such as: newsletter articles, member education and outreach interventions, provider education, member outreach interventions, medical record reviews, focus groups, and surveys.
• Analyzes, updates, and modifies procedures and processes to continually improve QI operations.
• Collects and summarizes performance data, identify opportunities for improvement, and present findings to Quality Improvement Committees.
• Leads and facilitates quality improvement teams in the development of QIPs, PIPs and QIAs
• Serves as knowledge expert for continuous quality improvement activities.
• Monitors and analyzes outcomes to ensure goals, objectives, outcomes, accreditation and regulatory requirements are met.
• Participates in site visit preparation and execution by regulatory and accreditation agencies (State agencies, CMS, AAAHC, URAC, NCQA,EQRO).
• Conducts internal auditing of compliance with regulatory and accreditation standards.-
• Supports the implementation of the quality reporting infrastructure.
• Pursues methods to ensure receipt of data required for trending and reporting of various QI work plan metrics, performs adequate data/barrier analysis, develops improvement recommendations, and deploys actions as approved.
• Assists in activities to prioritize clinical and service improvement initiatives.
• Participates in various QI committees and work groups convened to improve process and/or health outcomes, and contributes meaningful detail, based on functional knowledge. Completes follow-up as assigned.
• Manages and monitors assigned quality studies.
• Investigates and incorporates national best practice interventions to effect greater rate increases.
• Ensures that documentation produced and/or processed complies with state regulations and/or accrediting body requirements.
• Ensures assigned contract/regulatory report content is accurate and that submission adheres to deadline
• Must be a licensed RN in MO
• 3-5 years of Managed Care experience/Chart Review
• Knowledge of compliance, accreditation, service or quality improvement
• Knowledge of HEDIS
• Knowledge of federal and state regulations
• Experience with Medicaid and Medicare
• Medical record review experience
• Experience with patient assessment skills typical of nursing experience providing care for patients with various types of medical/surgical diagnoses
• Ability to effectively present information and respond to questions from families, members, and providers Intermediate
• Ability to create, review and interpret treatment plans Intermediate
• Ability to identify basic problems and procedural irregularities, collect data, establish facts, and draw valid conclusions Intermediate
If you are interested, please call, Courtney Phelps at 407-636-7030 x 232 and email your resume to cphelps@ healthcaresupport.com
The greatest compliment to our business is a referral.
If you know of someone looking for a new opportunity, please pass along my contact information! We offer referral bonuses of up to $100.00 for each placement.