Clinical Quality Improvement Nurse

Medical Mutual; Brooklyn (OH); Hybrid; USD 75,000 - 110,000; Full time

Benefits offered by this job

Equipment provided (laptop, monitors,…

Gym reimbursement

On-site cafeteria

Casual dress (business casual)

Job summary

Medical Mutual is seeking a Registered Nurse to support quality improvement initiatives, NCQA/HEDIS alignment, and CMS regulatory compliance. The role involves chart reviews, data abstraction, and creating reports to drive performance improvements across the health plan.

The candidate will collaborate with provider groups and cross-functional teams to enhance quality measures and accreditation outcomes. Hybrid role based in Brooklyn, OH with designated in-office days.

Qualifications

• Registered Nurse with Ohio license in good standing.
• BSN preferred; Master’s degree a plus.

Responsibilities

• Collaborate with quality improvement team to support studies, education materials, provider engagement and quality initiatives.
• Apply clinical expertise to collect HEDIS/study data via chart review and abstraction.
• Prepare narratives, reports, graphs, and procedures to support quality improvement and accreditation activities.
• Apply process and performance improvement methods to gain insight and measure effectiveness.
• Integrate findings into redesign of processes or clinical practices with cross-functional collaboration.
• Perform additional duties as assigned.

Skills

Project management

Research skills

MS Office

PDSA

DMAIC

Education

RN program (OH lic)

BSN preferred

Master's degree a plus

3 years RN experience

Tools

MS Office

Job description

Medical Mutual employees must submit their applications through MySource.

This is a hybridremote role based out of the Brooklyn, OH office, with employees expected to work onsite on designated inoffice days each week.

Job Summary

Applies process improvement methods to daily work to comply with National Committee for Quality Assurance (NCQA), accreditation standards and the Centers for Medicare & Medicaid Services (CMS) regulations for quality. Performs medical record reviews to derive analyses and supporting documentation to enhance NCQA, Healthcare Effectiveness Data and Information Set (HEDIS) and Medicare Star ratings as well as data analysis to recommend and implement process improvement methods and reporting. Supports and collaborates with provider groups to promote quality and oversight of quality vendors.

Responsibilities

• Collaborates with quality improvement team/management to support the development of studies, education materials, provider engagement, vendor management and quality initiatives that improve the quality of care provided to members across all lines of business.
• Applies clinical expertise to collect HEDIS and/or study data through chart review and abstraction
• Prepares narratives, reports, graphs, charts, flowcharts, and policy and procedures, to support quality improvement and accreditation activities.
• Applies process and performance improvement methods to gain insight and measure effectiveness.
• Integrates output of findings into the redesign of a process or clinical practice. Collaborates cross-functionally to develop and implement project plans.
• Performs other duties as assigned.

Education & Experience

• Graduate of a registered nursing program approved by the Ohio Board of Nursing.
• Bachelor of Science in Nursing preferred. Master's Degree a plus.
• 3 years clinical experience as a Registered Nurse preferably in a health plan.

Professional Certifications

• Registered Nurse with current State of Ohio unrestricted license
• Certified Professional in Healthcare Quality (CPHQ) or Lean Six Sigma certification preferred.

Technical Skills and Knowledge

• Good project management skills.
• Ability to conduct online research for updates of industry best practices.
• Intermediate Microsoft Office skills - (Word, PowerPoint, and Excel).
• Knowledge of process and performance improvement methods and tools: Plan Do Study Act (PDSA) or Define, Measure, Analyze, Improve and Control (DMAIC).
• Knowledge of NCQA, HEDIS and Medicare Star rating, health plan accreditation standards, and CMS regulations for quality preferred.

Benefits

A Great Place to Work

• We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.
• Whether you are working remote or in the office, employees have access to on-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available. Enjoy the use of weights, cardio machines, locker rooms, classes and more.
• On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.
• Discounts at many places in and around town, just for being a Medical Mutual team member.
• The opportunity to earn cash rewards for shopping with our customers.
• Business casual attire, including jeans.

Excellent Benefits and Compensation

• Employee bonus program.
• 401(k) with company match up to 4% and an additional company contribution.
• Health Savings Account with a company matching contribution.
• Excellent medical, dental, vision, life and disability insurance - insurance is what we do best, and we make affordable coverage for our team a priority.
• Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work/life benefits.
• Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
• After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.

An Investment in You

• Career development programs and classes.
• Mentoring and coaching to help you advance in your career.
• Tuition reimbursement up to $5,250 per year, the IRS maximum.
• Diverse, inclusive and welcoming culture with Business Resource Groups.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities Breathing rights: This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.