Listing Info

Job Details:Supports the development and implementation of quality improvement interventions and audits and assists in resolving deficiencies that impact plan compliance to regulatory and accreditation standards. Drives key quality improvement projects requiring the ability to work effectively in a matrix environment in order to receive needed data that reflects the overall health of the plan.

Works with QI Director to convene various QI committees and work groups, set agenda to drive desired meeting outcomes (based on contract and accreditation requirements), and ensure proper recording of committee activities.

Acts as knowledge expert for continuous quality improvement activities, educating staff of other functional areas regarding the QI process and accreditation requirements.

Performs various quality department functions and processes, such as quality of care complaint/adverse event review and assessment of medical record review results and recommend actions to address any identified improvement opportunities.

Requirements

Licenses/Certifications: Licensed Registered Nurse (RN). Appropriate state licensure

Special Skills

Knowledgeable of current trends in quality improvement in managed health care
Knowledgeable of DCH, DHR and CMS regulatory requirements
Knowledgeable of JCAHO, NCQA, HEDIS and CAHPS requirements
Ability and confidence to make decisions based on scope of the job
Ability to organize tasks/work environment in a fast paced environment
Ability to work on multiple projects and tasks on a daily basis, remaining calm under pressure
Ability to be flexible in the face of changing priorities
Ability to work effectively across departmental lines

Nurse Resolutions