Nurse Quality Manager: Medicaid QI & Policy Lead

DataStaff, Inc.; Raleigh (NC); Hybrid; USD 90,000 - 120,000; Full time

Benefits offered by this job

Competitive benefits package

401K program after 6 months

Paid vacation, sick and holiday leave

Job summary

DataStaff, Inc. is seeking a Clinical Nurse Quality Manager for a long-term contract in Raleigh, NC. The role is hybrid with 2x per week on-site.

The incumbent will develop, implement, and monitor quality improvement initiatives to improve Medicaid outcomes. The position requires strong leadership, advanced analytics, and extensive nursing experience. Key duties include coordinating QI activities, analyzing data from health plans, and advising leadership on KPIs and policy development to drive

Qualifications

• 2-3 years of Quality Improvement experience.
• Experience with HEDIS measures.
• Nursing experience preferred (5+ years).
• CPHQ or PMP or Six Sigma Yellow Belt certifications give advanced credit.
• Preferred experience with managed care, Medicaid, Medicare, or Accountable Care Organizations.
• Population health interventions knowledge is a plus.

Responsibilities

• Coordinate with key stakeholder teams inside and outside of DHB for enhancement of QI activities.
• Identify opportunities for improvement based on analysis of data from Health Plans, the State, and other data sources.
• Provide feedback to leadership on initiatives, KPIs, or cross-collaborative opportunities for strategic planning.
• Provide Clinical Quality Expertise on Policy Development of Quality Improvement Activities.
• Manage relationships with healthcare stakeholders, offering evidence-based recommendations and ongoing feedback.
• Collaborate with other Business Units to enhance interoperability of Medicaid Quality activities.
• Support leadership in developing person-centered, wholistic performance improvement policies.
• Communicate with Health Plans to enhance member experience and outcomes.
• Stay updated on quality improvement trends and CMS/HEDIS/NCQA guidelines.
• Lead 2-3 Quality Improvement activities per 12-month contract.
• Support other QPHE projects as needed.

Skills

Leadership

Advanced analytics

Stakeholder engagement

Communication skills

Data interpretation

Education

ADN RN: 5 years experience

BSN: 3-5 years experience

MSN: 2-3 years experience

CPHQ or PMP or Six Sigma Yellow Belt

Tools

Microsoft Office Suite

Excel

PowerPoint

Word

Data analysis software

Job description

DataStaff, Inc. is seeking a Clinical Nurse Quality Manager for a long-term contract in Raleigh, NC. The role is hybrid with 2x per week on-site.

The incumbent will develop, implement, and monitor quality improvement initiatives to improve Medicaid outcomes. The position requires strong leadership, advanced analytics, and extensive nursing experience. Key duties include coordinating QI activities, analyzing data from health plans, and advising leadership on KPIs and policy development to drive