Quality Program Nurse, RN — Elevate Care & Compliance

IEHP; Rancho Cucamonga (CA); On-site; USD 91,000 - 121,000; Full time

Benefits offered by this job

Competitive salary

Fitness center on-site

Medical/dental/vision insurance

Life and disability insurance

Career advancement

Wellness programs

Flexible Spending Account

CalPERS retirement

457(b) plan with match

Pet insurance

Job summary

IEHP is seeking a Quality Program Nurse (QPN) to implement Quality Management policies under the direction of the Manager, Quality Management Nurses. You will ensure DHCS regulatory requirements for Facility Site Review and Medical Record Review are met and support the Quality Program goals including HEDIS, CAHPS, and NCQA accreditation.

The role requires nursing licensure in California, CSR certification or willingness to obtain within 6 months, and 3+ years in QA, Utilization Management, or

Qualifications

• Three (3) or more years of any individual or combined experience in Quality Assurance, Utilization Management, Case Management, provider liaison duties, and/or clinical experience in a hospital/clinical setting
• Experience preferably in an HMO or Managed Care setting
• Possession of valid Certified Site Reviewer Certificate issued from DHCS or participating Medi-Cal Managed Health Plan Provider; willing to certify within 6 months of hire if not CSR
• Possession of an Active, unrestricted RN license issued by CA BRN

Responsibilities

• Implement Quality Management policies, procedures, and activities under the direction of the Manager, Quality Management Nurses
• Enforce DHCS regulatory requirements pertaining to Facility Site Review (FSR) and Medical Record Review (MRR) criteria
• Support IEHP Quality Program goals including HEDIS, CAHPS, and NCQA Accreditation

Skills

Nursing knowledge

Quality Assurance

Utilization Management

Case Management

Communication skills

Conflict resolution

Organizational skills

Education

Associate’s degree in Nursing

Bachelor’s degree in Nursing

CA RN license

CSR certification

Job description

IEHP is seeking a Quality Program Nurse (QPN) to implement Quality Management policies under the direction of the Manager, Quality Management Nurses. You will ensure DHCS regulatory requirements for Facility Site Review and Medical Record Review are met and support the Quality Program goals including HEDIS, CAHPS, and NCQA accreditation.

The role requires nursing licensure in California, CSR certification or willingness to obtain within 6 months, and 3+ years in QA, Utilization Management, or