QI Nurse

Health Plan of San Joaquin/Mountain Valley Health Plan; French Camp (CA); Remote; USD 80,000 - 100,000; Full time

Job summary

A leading healthcare organization in California is seeking a QI Nurse to enhance quality improvement activities. This remote role involves conducting facility site reviews, HEDIS audits, and managing complaints. Ideal candidates will have significant clinical experience and a strong nursing background. Join a mission-driven team focused on community health and wellness.

Benefits

Competitive salary and comprehensive benefits

Generous paid time off

Retirement plans

Education reimbursement

Community-focused organization

Qualifications

• Five or more years of clinical nursing experience.
• Unrestricted Registered Nurse license in California.

Responsibilities

• Conducts quality improvement activities related to HEDIS and site reviews.
• Researches and analyzes complaints and grievances.
• Plans and monitors internal quality activities.

Skills

Clinical skills

Analytical skills

Problem-solving skills

Communication skills

Interpersonal skills

Organizational skills

Education

Graduation from an accredited nursing school

Job description

Join to apply for the QI Nurse role at Health Plan of San Joaquin/Mountain Valley Health Plan.

We are currently hiring a QI Nurse to join our team! Must reside in California - remote position.

What You Will Be Doing:

Under general supervision, performs quality improvement activities related to HEDIS, facility site review, and complaint/grievance resolution. Responsible for planning, implementing, and monitoring quality improvement activities to ensure members receive quality care in compliance with HPSJ, regulatory, and contractual requirements. Work is semi-routine, occasionally varied and moderately complex, requiring a limited to moderate degree of discretion and independent judgment.

Facility Site Reviews

• Schedules and conducts facility site reviews as required.
• Develops corrective action plans based on findings; submits for approval.
• Implements approved corrective action plans; collaborates with provider to resolve issues.
• Monitors, analyzes, and reports on progress; escalates as required.

HEDIS

• Assists with development and implementation of quality improvement plans based on HEDIS results.
• Conducts HEDIS chart audits.
• Monitors, analyzes, and reports on progress of corrective actions; escalates as necessary.

Internal QI

• Plans internal quality activities for identified problems using PDCA.
• Leads CQI team in identifying and analyzing process barriers.
• Recommends and implements solutions.
• Monitors, analyzes, and reports on progress; conducts internal quality audits.

Complaints and Grievances

• Researches and analyzes external complaints and grievances.
• Recommends solutions; implements corrective actions.
• Participates in committees, prepares reports, and analyzes data to make recommendations.

Required Qualifications:

• Graduation from an accredited nursing school.
• Five or more years of clinical nursing experience.
• Unrestricted Registered Nurse license in California.

Preferred Qualifications:

• Experience in healthcare quality activities, managed care, and working with Medi-Cal and/or Medicare populations.

Skills and Knowledge:

• Strong clinical, analytical, and problem-solving skills.
• Knowledge of Title 22, NCQA standards, and quality metrics.
• Excellent communication, interpersonal, and organizational skills.

HPSJ Perks and Benefits:

• Competitive salary and comprehensive benefits.
• Generous paid time off and retirement plans.
• Additional perks including insurance, education reimbursement, and community-focused organization.

Our vision is to continuously improve the health of our community, and our mission is to provide healthcare value and advance wellness through community partnerships. We are an equal opportunity employer committed to diversity and inclusion.