Healthplan Quality Supervisor

Nascentia Health, Inc.; City of Syracuse (NY); Sur place; USD 90 000 - 105 000; Plein temps

Avantages offerts par ce poste

401k with generous Employer match

Tuition Reimbursement for BSN after 6 

Paid Time Off

Holidays

Extended Sick Leave

Short/Long term Disability

Employee Assistance Program (EAP)

Much More!

Résumé du poste

Nascentia Health, Inc. in New York seeks a Registered Nurse to lead the Quality Assurance team, ensuring adherence to policy, procedures, and regulatory requirements across MLTC and DSNP programs.

You will act as a senior consultant to QA staff, care managers, and education, driving audit accuracy and timely reporting. The role emphasizes mentorship, staff development, and collaboration with Education and Care Management to deliver compliant care and continual process improvement.

Qualifications

• New York State RN license with current registration; minimum 1 year medical-surgical experience
• BSN with one year home care case management experience preferred

Responsabilités

• Serve as expert consultant to the QA Staff and supervisors, care managers and education department
• Oversee the QA Team and ensure staff adhere to Nascentia Health policies and procedures
• Delegate QA tasks for MLTC and DSNP
• Review QA Audits for accuracy, completeness and trends
• Coordinate responses to DOH TAC complaints
• Lead Plan on PIP projects per IPRO instructions
• Complete MLTC DOH quarterly reporting with departments for accuracy and compliance
• Mentor new personnel and promote teamwork
• Ensure staff meet job role expectations timely
• Oversee QA staff competency under Director guidance
• Provide coverage for QA during absences
• Collaborate with Education Department to provide QA/CM education
• Participate in team meetings and committees
• Maintain HIPAA and confidentiality standards
• Attend in-services and professional development
• Engage in quality improvement Care Management activities
• Address issues identified by QA promptly
• Perform other related duties

Connaissances

Organizational skills

Time management

Communication skills

Conflict management

Independent decision making

Computer literacy

MS Office

Medicare/Medicaid knowledge

Chronic disease management

Team collaboration

Formation

RN NYS license

BSN preferred

Description du poste

Performance Responsibilities and Standards:

• Serves as an expert consultant to the QA Staff as well as supervisors, care managers and the education department.
• Oversees the QA Team and ensures staff adhere to the policies and procedures of Nascentia Health
• Delegation of QA tasks for both the MLTC and DSNP.
• Reviews QA Audits for accuracy, completeness and trends.
• Oversees and coordinates the response to DOH TAC complaints
• Oversees compiling results of audits and reports for the quarterly internal quality meetings and MAC.
• Leads the Plan on PIP projects as directed by IPRO, including but not limited to creation of process, care planning and reporting.
• Completes and submits the MLTC DOH quarterly reporting, in collaboration with various departments, and ensures accuracy and compliance.
• Serves as a lead in the orientation of new personnel, mentors peers and promotes collaborative teamwork.
• Through oversight and collaboration, ensures that staff meet all of the job role expectations timely and appropriately.
• Oversees QA staff to ensure competency in skill set such as review of auditing, per regulatory/agency guidelines under direction of Director of Health Plan Quality and Utilization.
• Performs employee reviews and performance appraisals of the QA staff.
• Provides coverage for the QA Team during time of absence.
• Works collaboratively with Education Department in providing education to the QA and CM team. Also verifies attendance and ensures that education is provided to those that are absent or need reinforcement.
• Participates in regular team meetings and activities.
• Participates in departmental and organizational committees and meetings as applicable.
• Maintains a working knowledge of, and adheres to applicable federal/state regulations including, but not limited to patient confidentiality, release of information, and HIPAA.
• Interacts in a manner, which is professional, respectful, positive, helpful, and promotes trust and commitment to co-worker and maintains appropriate professional boundaries.
• Attends agency in-services and educational programs and maintains professional growth and development.
• Participates in the quality improvement Care Management activities of the organization.
• Clarifies issues identified by QA and Care Management and actively addresses concerns in a timely manner.
• Performs other related duties as requested.

Requirements:

• Strong organizational and time management skills.
• Ability to manage conflict, stress and multiple simultaneous work demands in an effective, professional manner.
• Ability and willingness to self-motivate, prioritize, and be willing to change processes to improve effectiveness efficiency. Adapts to changing patient or organizational priorities.
• Ability to make independent decisions in accordance with established policies and procedures. Decisions and problem solving require a combination of analysis, evaluation, and interpretive thinking.
• Computer literate and working knowledge of basic computer skills and Microsoft Office programs.
• Excellent written, verbal and listening communication skills.
• Listens to or acknowledges the viewpoints of others.
• Sends clear, consistent messages to members/family/staff.
• Utilizes varied communication styles to communicate to produce results.
• An understanding of Medicare/Medicaid regulatory and entitlements
• Knowledge of chronic disease management
• Demonstrated ability to work with a multi discipline team.

Qualifications:

• Licensed and currently registered to practice as a Registered Professional Nurse in New York State, with minimum of 1-year medical surgical experience. A BSN with one year of home care case management experience preferred.

Physical Requirements:

• Ability to drive to and from other offices as needed for education purposes in varying weather conditions.
• Physical exam signed by a physician showing you are in good health and have the immunizations required by the NYS DOH.
• Standing, sitting, bending, walking, and driving are standard postures.
• Frequently uses a laptop computer.
• Sensory requirements include speech, vision, smell, and hearing.
• Lifting requirements of up to 20 pounds.
• Bloodborne Pathogens Exposure Category I - Employee has tasks that routinely involve exposure or potential exposure to blood, body fluids or tissues.

Competitive Salary

This is an S05 exempt position with a min-max rate of: $90,340- $104,809 /annually with:

• Eligible Site for the Nurse Corps Loan Repayment Program
• 401k with generous Employer match
• Tuition Reimbursement for BSN after 6 months of employment
• Exceptional work/life balance - no rotating shifts, holidays or weekends
• Partially funded HSA
• Employee Recognition Platform
• Paid Time Off, Holidays, and Extended Sick Leave
• Short/Long term Disability
• Employee Assistance Program (EAP)
• Much More!

About Nascentia Health:

Nascentia Health is leading the way in home care, post acute care and long-term community health. A healthcare system without walls, Nascentia is an innovator in the concept of healthcare, truly focused on the patient as a whole. By serving people in their homes, Nascentia Health is able to provide true holistic care. We can address immediate needs, help support positive long term medical and lifestyle choices that provide for better outcomes, leverage cutting edge in-home care technologies, and help avoid unnecessary visits to busy healthcare facilities.

Our employees are our greatest asset. They work hard every day to make our system amazing and are dedicated to our mission of being the premier home and community-based care system for the regions we serve. We want everyone to love what they do, be excited about coming to work, and take pride in being part of our team.

Nascentia Health is an Equal Opportunity Employer (EOE)

Employment is contingent upon negative results of a pre-hire drug screen