Quality Program RN — Leader in Quality & Compliance

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

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.