Quality Improvement RN

Healthcare Support Staffing; Louisville (KY); On-site; USD 70,000 - 90,000; Full time

Benefits offered by this job

Referral bonuses up to $100.00

Job summary

A leading healthcare recruiting firm in the United States seeks a Quality Improvement Manager to oversee healthcare quality initiatives. The ideal candidate will be a licensed RN in Missouri with 3-5 years of experience in Managed Care and knowledge of compliance and HEDIS. Responsibilities include managing quality studies, analyzing data, and ensuring compliance with state regulations. This role offers the opportunity to work with top healthcare providers and access to rewarding career opportunities.

Qualifications

• Must be a licensed RN in MO.
• 3-5 years of Managed Care experience/Chart Review.
• Knowledge of compliance, accreditation, service or quality improvement.

Responsibilities

• Manage and monitor quality improvement initiatives.
• Analyze, update, and modify procedures to improve QI operations.
• Collect and summarize performance data for Quality Improvement Committees.

Skills

Managed Care experience

Chart Review

Knowledge of compliance

Knowledge of HEDIS

Knowledge of federal and state regulations

Patient assessment skills

Effective presentation

Treatment plan interpretation

Education

Licensed RN in MO

Job description

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!

Job Description

• Manages and monitors quality improvement initiatives including, but not limited to, development and implementation of preventive health and chronic disease outcome improvement interventions such as: newsletter articles, member education and outreach interventions, provider education, member outreach interventions, medical record reviews, focus groups, and surveys.
• Analyzes, updates, and modifies procedures and processes to continually improve QI operations.
• Collects and summarizes performance data, identify opportunities for improvement, and present findings to Quality Improvement Committees.
• Leads and facilitates quality improvement teams in the development of QIPs, PIPs and QIAs.
• Serves as knowledge expert for continuous quality improvement activities.
• Monitors and analyzes outcomes to ensure goals, objectives, outcomes, accreditation and regulatory requirements are met.
• Participates in site visit preparation and execution by regulatory and accreditation agencies (State agencies, CMS, AAAHC, URAC, NCQA, EQRO).
• Conducts internal auditing of compliance with regulatory and accreditation standards.
• Supports the implementation of the quality reporting infrastructure.
• Pursues methods to ensure receipt of data required for trending and reporting of various QI work plan metrics, performs adequate data/barrier analysis, develops improvement recommendations, and deploys actions as approved.
• Assists in activities to prioritize clinical and service improvement initiatives.
• Participates in various QI committees and work groups convened to improve process and/or health outcomes, and contributes meaningful detail, based on functional knowledge. Completes follow-up as assigned.
• Manages and monitors assigned quality studies.
• Investigates and incorporates national best practice interventions to effect greater rate increases.
• Ensures that documentation produced and/or processed complies with state regulations and/or accrediting body requirements.
• Ensures assigned contract/regulatory report content is accurate and that submission adheres to deadline.

Qualifications

• Must be a licensed RN in MO.
• 3-5 years of Managed Care experience/Chart Review.
• Knowledge of compliance, accreditation, service or quality improvement.
• Knowledge of HEDIS.
• Knowledge of federal and state regulations.
• Experience with Medicaid and Medicare.
• Experience with patient assessment skills typical of nursing experience providing care for patients with various types of medical/surgical diagnoses.
• Ability to effectively present information and respond to questions from families, members, and providers. Intermediate.
• Ability to create, review and interpret treatment plans. Intermediate.
• Ability to identify basic problems and procedural irregularities, collect data, establish facts, and draw valid conclusions. Intermediate.

Additional Information

If you are interested, please call, Courtney Phelps at 407-636-7030 x 232 and email your resume to cphelps@ healthcaresupport.com

The greatest compliment to our business is a referral.

If you know of someone looking for a new opportunity, please pass along my contact information! We offer referral bonuses of up to $100.00 for each placement.