Nurse Quality Management

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

Job summary

University Health in San Antonio, TX seeks a seasoned nurse to coordinate and lead the Quality Management department, ensuring NCQA and HEDIS compliance across plans and providers. You will collaborate with Community First Health Plans and hospital departments to monitor performance and drive data-driven improvements.

Requirements include graduation from an accredited nursing program, a BSN or health care-related bachelor's, 5+ years of healthcare experience, and proficiency with Microsoft

Qualifications

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

Responsibilities

• Coordinates with Community First Health Plans and departments to meet NCQA and HEDIS requirements for Quality Management.
• Monitors performance on quality metrics and benchmarks against state and federal standards.
• Manages data collection systems and develops procedures to monitor, validate, and reconcile data for accuracy.
• May lead or facilitate process improvement efforts.
• Oversees and conducts review, investigation, and analysis of member-level clinical care data and provider performance against standards of care.

Skills

Data analysis

Quality improvement

Microsoft Office

Communication skills

Interpersonal skills

Process improvement leadership

Education

Bachelor's degree in nursing or related field

Graduation from an accredited school of professional nursing

Tools

Excel

Word

Outlook

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.