Nurse Quality Management

University Health; Hondo (TX); On-site; USD 85,000 - 110,000; Full time

Job summary

University Health seeks a skilled professional to coordinate and optimize quality management activities across departments, ensuring NCQA/HEDIS compliance and accurate data reporting.

The role emphasizes data analysis, performance monitoring, and process improvement to drive high standards of patient care within the health system.

Qualifications

• Graduation from an accredited school of professional nursing is required.
• Five or more years of relevant healthcare experience is required.
• Experience with data analysis and preparation of quality improvement reports is preferred.
• Excellent communication and interpersonal skills are required.
• Quality Management certification such as CPHQ or CHCQM is preferred.

Responsibilities

• Coordinates and collaborates with Community First Health Plans and departments to ensure NCQA/HEDIS compliance.
• Monitors performance on quality metrics and benchmarks against state and federal standards.
• Manages data collection systems and develops procedures for monitoring, validating, and reconciling data for accuracy.
• May lead or facilitate process improvement efforts.
• Oversees review and analysis of member-level clinical care data as it compares to standards of care.

Skills

Data analysis

Communication skills

Process improvement

Team leadership

Education

Nursing degree required

Bachelor's in nursing/clinical informatics or related field preferred

Tools

Microsoft Office

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.