Nurse Quality Management

University Health; Boerne (TX); On-site; USD 65,000 - 100,000; Full time

Job summary

University Health in Boerne, TX seeks a Nursing professional to coordinate quality programs with emphasis on NCQA and HEDIS compliance. You will monitor performance, manage data collection systems, and lead process improvements to ensure high standards of member care.

The role requires RN licensure in Texas, 5+ years in healthcare, and strong communication skills. Experience with quality reporting and MS Office is preferred within a collaborative team environment.

Qualifications

• Graduation from an accredited school of professional nursing is required.
• Bachelor's degree in nursing, clinical informatics, or other health care related field preferred.
• Five or more years of relevant healthcare experience required.
• Experience with data analysis and preparing quality improvement reports preferred.
• Excellent communication and interpersonal skills required.
• Quality Management certification such as CPHQ or CHCQM preferred.
• Working knowledge of continuous process improvement principles and standard coding products preferred.

Responsibilities

• Coordinate with Community First Health Plans and departments to ensure NCQA/HEDIS standards are met in Quality Management.
• Monitor performance on quality metrics and benchmark against state/federal standards.
• Manage data collection systems and develop procedures for monitoring, validating, and reconciling data for accuracy.
• Lead or facilitate process improvement initiatives as needed.
• Oversee and perform review, investigation, and analysis of member-level clinical care data compared to standards of care.

Skills

Data analysis

Communication skills

Process improvement

Healthcare data interpretation

Team collaboration

Education

Bachelor's degree in nursing

Bachelor's degree in clinical informatics or related health care field

Quality Management certification (CPHQ/CHCQM)

Tools

Microsoft Office

Data visualization tools

Job description

POSITION SUMMARY/RESPONSIBILITIES

Coordinates and collaborates with Community First Health Plans, Inc. (Community First), various departments to ensure that contractual, regulatory, and accreditation requirements, including National Committee for Quality Assurance (NCQA) and Healthcare Effectiveness Data and Information Set (HEDIS) are met as it pertains to the Quality Management Department. Monitors Community First performance on various quality metrics and benchmarks them against state and federal standards. Provides ongoing management of data collection systems and the development of procedures for monitoring, validating, and reconciling data for accuracy. May serve as a leader/facilitator of process improvement efforts. Provides oversight of and performs functions of review, investigation, and analysis of member-level clinical care data and provider performance as it compares to standards of care.

EDUCATION/EXPERIENCE

Graduation from an accredited school of professional nursing is required. Bachelor's degree in nursing, clinical informatics, or other health care, or other health care related field is preferred. Five or more years of relevant healthcare experience is required. Experience in data analysis and preparation of quality improvement or related reports is preferred. Experience with Microsoft Office (Outlook, Word, Excel). Excellent communication and interpersonal skills are required. Quality Management certification such as CPHQ or CHCQM is preferred. Working knowledge of continuous process improvement principles and standard coding products is preferred.

LICENSURE

Current licensure as a Registered Nurse in the State of Texas is required.