Nurse Quality Management

University Health; Pleasanton (TX); On-site; USD 90,000 - 120,000; Full time

Job summary

Community First Health Plans, Inc. requires a qualified Nursing professional to ensure NCQA and HEDIS compliance, coordinating with multiple departments to meet contractual and regulatory standards.

The role includes overseeing data collection systems and leading process-improvement efforts to enhance quality of care. Ideal candidates will have a Texas RN license, 5+ years in healthcare, and experience with data analysis and quality reporting; CPHQ/CHCQM preferred.

Qualifications

• Graduation from an accredited school of professional nursing is required.
• Bachelor's degree in nursing, clinical informatics, or other health care related field is preferred.
• Five or more years of relevant healthcare experience is required.
• Experience with data analysis and preparation of quality improvement reports is preferred.
• Quality Management certification such as CPHQ or CHCQM is preferred.

Responsibilities

• Coordinate with Community First Health Plans, Inc. to meet NCQA and HEDIS requirements.
• Monitor quality metrics and benchmark against state and 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.
• Review, investigate, and analyze member-level clinical care data as compared to standards of care.

Skills

Data analysis

Communication

Interpersonal skills

Process improvement

Leadership

Education

Bachelors in Nursing

Clinical informatics or related health field

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.