Nurse Quality Management

University Health; Seguin (TX); On-site; USD 85,000 - 115,000; Full time

Job summary

University Health in Seguin, TX is seeking a seasoned quality management professional to ensure NCQA and HEDIS compliance across the organization. You will coordinate with Community First Health Plans and multiple departments to monitor and improve data accuracy and reporting.

The role entails oversight of data collection systems, development of monitoring procedures, and potential leadership of process improvement initiatives to meet state and federal standards and deliver high-quality care.

Qualifications

• Bachelor's degree in nursing or clinical informatics required; advanced degrees preferred.
• 5+ years of healthcare experience required.
• Experience in data analysis and quality improvement reports preferred.
• Working knowledge of continuous process improvement principles and coding products preferred.

Responsibilities

• Coordinate with Community First Health Plans to meet NCQA/HEDIS requirements.
• Monitor quality metrics and benchmark against state/federal standards.
• Oversee data collection systems and reconcile data for accuracy.
• Lead process improvement initiatives when appropriate.

Skills

Data analysis

Communication skills

Interpersonal skills

Process improvement

Education

Bachelor's degree in nursing

Clinical informatics

Health care related field

Tools

Microsoft Office

Excel

Outlook

Word

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.