RN Manager of Quality Improvement

Location: Camarillo, CA
Date Posted: 11-01-2018
CareNational
RN Manager of Quality Improvement – Health Plan
Camarillo, CA

$$$ Generous Relocation Package available to attract top-talent from around the Nation! $$$
 
Manager of Quality Improvement Job Summary:
 
  • The RN Manager of Quality has primary responsibility for the HEDIS data collection process, in addition to being responsible for the supervision and management of designated personnel within the QI department.
  • In collaboration with the Senior Quality Improvement HEDIS Analyst, this position works with IT to identify solutions and meet deadlines associated with the HEDIS process.
  • The position will work closely with internal partners from the claims, IT, Health Services and Member Services area to ensure the integrity of the plan data.
  • The RN Manager of Quality will be responsible for coordinating with the State for data submission as well as any mandated oversight processes.
  • Utilize strong understanding of HEDIS measures as well as a working knowledge of how plan claim, membership and provider data affects the outcomes of the HEDIS measures.
  • Responsible for coordinating all aspects of the process including training of HEDIS abstractors, IRR, and specialists involved in administrative data pulls and manual chart abstraction.
  • In addition, the QI Manager will assist the Director of Quality and the QI Project Manager in designing and implementing additional Quality Improvement Studies.
  • The RN Manager of Quality will contribute to the overall Quality Improvement program by identifying issues and
    implementing corrective actions when needed. He/she will work with other departments to design initiatives to improve study results and will lead re-measurement efforts to determine effectiveness.
 
Manager of Quality Improvement Background:
 
  • Requires Registered Nurse (R.N.) license and a Bachelor’s of Science in Nursing (BSN) or healthcare related field; Master’s degree is a plus.
  • Around 3-5 years of acute care clinical nursing experience.
  • At least 2-3 years’ experience in a Managed Care Organization (Health Plan/HMO/MSO/TPA/IPA/etc); Medi-Cal experience is a plus.
  • Roughly 5 years’ experience in health plan Quality Improvement, Risk Management, Compliance, and/or Accreditation, with emphasis on HEDIS measures and other CMS-driven quality metrics.
  • At least 1-3 years previous management experience, in roles of increasing responsibility, which included hiring and supervising clinical or non-clinical personnel during a full HEDIS season.
  • Experience in Quality Improvement activities such as medical record review, designing and implementing performance improvement projects and/or utilization management activities.
  • Strong computer proficiency (MS Office) and typing skills are necessary.
  • Skilled in influencing, leading and directing individuals in multiple functional areas.
  • Able to transform assignments from high-level objectives into independently established detailed goals.
  • Excellent verbal and written communication skills, as well as exceptional critical thinking skills.
 
 #CLINICAL
 
PRASHANT PATEL
STRATEGIC DIRECTOR
CareNational
prashant@carenational.com
480.646.3275 (CALL – TEXT – FAX)
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