Job Description
• 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
Qualifications
• 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
Additional Information
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.
Company Description
HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!