Quality Program Nurse, RN (Remote with field work)

Inland Empire Health Plans; California (MO); Remote; USD 90,000 - 110,000; Full time

Benefits offered by this job

Competitive salary

On-site fitness center

Medical, dental, vision insurance

Life and disability coverage

Career development opportunities

Wellness programs

Job summary

Inland Empire Health Plans seeks a Quality Program Nurse to implement quality management policies, ensuring DHCS standards for FSR and MRR are met. You will contribute to achieving IEHP's quality goals with an emphasis on patient care and regulatory compliance.

The role requires an RN license in California, CS R certification or willingness to obtain within six months, and progressive experience in QA, utilization management, or case management within a hospital/clinical setting.

Qualifications

• 3+ years in Quality Assurance, Utilization Management, Case Management, or clinical hospital/clinical experience.
• Experience in an HMO or Managed Care setting preferred.
• Associates degree in Nursing required; Bachelor’s degree preferred.
• Active RN license in California required; CSR certificate preferred or willing to obtain within 6 months.

Responsibilities

• Implement Quality Management policies, procedures, and activities.
• Enforce DHCS regulatory requirements for Facility Site Review (FSR) and Medical Record Review (MRR).
• Support IEHP Quality Program goals including HEDIS, CAHPS, and NCQA Accreditation.

Skills

Nursing principles & evidence-based

Computer applications

Organizational skills

Time-management

Written communication

Interpersonal skills

Conflict resolution

Multi-project management

Travel readiness

Education

Associate’s degree in Nursing

Bachelor’s degree in Nursing

Certified Site Reviewer Certificate (CSR)

RN license (California BRN)

Tools

Computer applications

Job description

What you can expect!

Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!

Under the direction of the Manager, Quality Management Nurses, Quality Program Nurses (QPN) are responsible for the implementation of Quality Management policies, procedures, and activities. QPN’s enforce DHCS regulatory requirements as pertaining to Facility Site Review (FSR) and Medical Record Review (MRR) criteria.

Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

Perks

IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more.

• Competitive salary
• State of the art fitness center on-site
• Medical Insurance with Dental and Vision
• Life, short-term, and long-term disability options
• Career advancement opportunities and professional development
• Wellness programs that promote a healthy work-life balance
• Flexible Spending Account – Health Care/Childcare
• CalPERS retirement
• 457(b) option with a contribution match
• Paid life insurance for employees
• Pet care insurance

Education & Requirements

• 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
• Associate’s degree in Nursing from an accredited institution required
• Bachelor’s degree in Nursing from an accredited institution preferred
• Possession of valid Certified Site Reviewer Certificate issued from DHCS or participating Medi-Cal Managed Health Plan Provider
• If not a CSR, the candidate should be willing and able to get certified within 6 months of hire
• Possession of an Active, unrestricted, and unencumbered Registered Nurse (RN) license issued by the California BRN required
• Valid State of California driver's license and valid automobile insurance

Key Qualifications

• Knowledgeable and understanding of nursing principles & evidence based practices
• Computer applications: spreadsheet, database, and word processing.
• Strong organizational, time-management, and critical thinking skills
• Excellent written and verbal communication and interpersonal skills.
• Highly skilled in interpersonal communication, including conflict resolution.
• Minimal to moderate physical activity; may include standing, bending, sitting for long periods of time and repetitive motion
• Ability to manage multiple projects with completing deadlines and changing priorities
• Automobile travel within the Inland Empire
• May periodically be required to report to IEHP’s main campus for in-person meetings or for other business needs as determined by IEHP leadership