Quality Improvement RN

Daily Responsibilities:

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 dead

Must be a licensed RN

• 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

Advantages of this Opportunity:

• Competitive salary, negotiable based on relevant experience
• Benefits offered, Medical, Dental, and Vision
• Fun and positive work environment

• Please reach out to Christine Morta at (407) 233-0769.

• Apply now for immediate consideration!