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Job Description
- Req#: 43747
Employer Industry: Healthcare Solutions
Why consider this job opportunity:
- Flexible work solutions including remote options
- Competitive pay
- Paid time off including holidays and volunteer events
- Health insurance coverage for you and your dependents on Day 1
- 401(k) and tuition reimbursement opportunities
- Chance to make a significant impact on members' well-being and drive organizational excellence
What to Expect (Job Responsibilities):
- Perform clinical Quality of Care (QOC) reviews, including all sentinel events and member concerns
- Drive annual medical record review activities, including HEDIS reporting and adherence to Clinical Practice Guidelines
- Collaborate across departments to support accreditation efforts and implement clinical quality performance improvement initiatives
- Review and suggest new and/or improved quality management activities using Plan-Do-Study-Act Cycles
- Develop and analyze QOC reports for Quality Assessment and Performance Improvement (QAPI) to identify trends and opportunities for enhancing patient outcomes
What is Required (Qualifications):
- Associate's Degree in Nursing; Bachelor's Degree preferred
- Minimum of 3 years of clinical experience in critical care required
- Minimum of 3 years in clinical or service quality improvement/health care delivery or relevant experience required
- Current and unencumbered Registered Nurse license
- Experience managing a complete project lifecycle, from initiation and planning to execution and closing
How to Stand Out (Preferred Qualifications):
- Knowledge of quality improvement processes and data analysis in managed care
- Expertise in Long-Term Services and Supports (LTSS) program areas
- Competent in Microsoft Office Suite, including document formatting in Word, basic formulas and data entry in Excel, and presentation design in PowerPoint
- Ability to produce error-free documentation and correspondence
- Ability to evaluate complex clinical problems and interpret data from various sources within a record
#HealthcareSolutions #QualityImprovement #RegisteredNurse #RemoteWork #CareerOpportunity
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