RN Quality Improvement Coordinator

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

Benefits offered by this job

Competitive salary

Medical benefits

Dental benefits

Vision benefits

Job summary

A national healthcare staffing firm in Sacramento is seeking a Registered Nurse with Quality Improvement experience. The role entails auditing health plans, conducting compliance reviews and traveling to hospitals. Candidates should possess over 3 years of clinical experience and 2 years in quality improvement. This position offers a competitive salary, negotiable based on experience, and includes benefits such as medical, dental, and vision insurance. Working hours are Monday to Friday, 8:00 am to 5:00 pm.

Qualifications

• 3+ years of clinical experience required.
• 2+ years of quality improvement experience must be demonstrated.

Responsibilities

• Auditing charts to ensure correct actions by the health plan.
• Traveling to hospitals to review charts, accounting for 50% of the job.
• Conducting compliance reviews and quality audits.
• Review delegated entities for quality, service, utilization and credentialing.

Skills

Clinical experience

Quality improvement

Data analysis

Communication

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

Are you an Registered Nurse with Quality Improvement experience that is looking for a new opportunity with a prestigious healthcare company? Do you want the chance to advance your career by joining a rapidly growing company? If you answered “yes" to any of these questions – this is the position for you!

Daily Responsibilities

• These candidates will be looking auditing charts to make sure the health plan as a whole is taking necessary and correct action
• They will be pulling information from charts for core measures and inputting into databases
• They will be traveling to hospitals in the area to review charts (this will be 50% of their job)
• Conduct review of delegated entities for compliance with quality, service performance and utilization, credentialing reviews and medical record audits
• Perform community activities related to clinical initiatives such as health fairs and communicate with agencies and providers
• Perform quality on site reviews of delegated entities, physician office/clinics, resolve quality issues, generate written summary of findings and follow up as directed by the Medical Director and/or Credentialing and Quality Improvement Committee (QIC)
• Document, investigate and resolve formal and informal complaints, risk management and sentinel events related to quality of care issues
• Audit medical records, review administrative claims and analyze data and interventions for quality improvement studies and activities
• Function as the primary liaison between community resources/agencies and the company related to clinical initiatives and technical guidance
• Schedule and chair meetings with delegated entities in accordance with their contract
• Gather data and compile various utilization and quality improvement reports
• Develop and implement Corrective Action Plans
• Recommend changes/enhancements to the Quality Improvement policies and procedures
• Identify best practices, research new processes and recommend program enhancements
• Coordinate QIC activities and monthly meetings
• Oversee the enforcement of contract terms regarding data submission for delegated entities
• Participate in the development of reporting and data outcome reports.

Qualifications

• 3+ years of clinical experience
• 2+ years of quality improvement (chart review) experience

Additional Information

Hours for this Position: Monday – Friday, 8:00am – 5:00pm

Advantages of this Opportunity

• Competitive salary, negotiable based on relevant experience
• Benefits offered, Medical, Dental, and Vision