Quality Program Nurse, RN (Remote with field work)

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

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.

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

Start your journey towards a thriving future with IEHP and apply TODAY!

Pay Range

• $91,249.60 USD Annually - $120,910.40 USD Annually