Job Details |
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| Quality Improvement RN - Remote | |
| Job ID: | 00004JK5 |
| Category: | MedicalDental |
| Location: | CA Camarillo |
| Hours: | 40 Monday to Friday 8am to 5pm |
| Pay: | $40.00 $45.00 |
| Quality Improvement RN Remote | |
| Job Description The Quality Improvement QI Nurse will support the Quality Improvement Program, assisting the health plan to successfully achieve organizational objectives for quality and patient safety. This position will be responsible for core clinical functions within the Quality Improvement department, including quality reviews, reporting, and performance improvement activities. Work closely with other departments of the Health Plan, the Ql team, and Chief Medical Officer to achieve the goals of the QI department. Lead the investigation, processing, and reporting of identified potential quality issues PQIs following the Plans procedures and timelines. Track and trend PQI outcomes for the purpose of QI reporting and prioritization of actionsinterventions. Annually review and edit relevant QI policies and procedures per APL updates, regulatory requirements, andor 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. Participate in departmental quality improvement activities and audits, including but not limited to, medical record review, performance improvement projects PIPs, PDSA processes, and CQI activities. Lead, facilitate andor participate in relevant committees and work groups prepare reports, data or other materials for committee presentation. Complete project-related communications, including job aides, memberphysician communications, work plansaction plans, graphical analyses, and agendasminutes, as applicable. Research best practices, national and regional benchmarks, and industry standards in order to help promulgate quality outcomes for the Plan. Demonstrate strong leadership skills and work ethic, with t | |
| Skills Required BA Degree in Nursing or similar. 2+ yrs of clinical exp in Quality Improvement, Risk Mgmt or Accreditation. Prior exp with Potential Quality Issues PQIs. Analytical and problem solving skills. Strong communication skills. | |
| Skills Preferred Knowledge of quality improvement processes in a managed care environment. Knowledge of DHCS requirements, NCQA Accreditation standards and HEDIS. | |