RN QI Specialist – HEDIS RN / LPN

Cypress, California

Intro:

Are you an experienced RN or LPN with  QI or HEDIS experience 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!

Position Summary:

Supports the development and implementation of quality improvement interventions and audits and assists in resolving deficiencies impacting plan compliance to regulatory and accreditation standards. Interfaces with a diverse range of clinical and administrative professionals resolves complex issues and performs data analytic and reporting activities.

Pay Range: $30.00-35.00

Hours for this Position: Monday-Friday – Daytime shift

Advantages of this Opportunity:

• Competitive salary
• Fun and positive work environment

Required Skills

What We Look For:

• 2+ years of experience in Quality Improvement Required-
• 3+ years of experience in Managed Care Required-
• Other Experience in compliance and accreditation Required-
• Other Knowledge of federal and state regulations/requirements

Responsibilities

More Insight of Daily Responsibilities: 

• Manages and monitors quality improvement initiatives including, but not limited to, development and implementation of preventive health and chronic disease outcome improvement interventions such as: newsletter articles, member education and outreach interventions, provider education, member outreach interventions, medical record reviews, focus groups, and surveys.
• Analyzes, updates, and modifies procedures and processes to continually improve QI operations.
• Collects and summarizes performance data, identify opportunities for improvement, and present findings to Quality Improvement Committees.
• Leads and facilitates quality improvement teams in the development of QIPs, PIPs and QIAs
• Serves as knowledge expert for continuous quality improvement activities.
• Monitors and analyzes outcomes to ensure goals, objectives, outcomes, accreditation and regulatory requirements are met.
• Participates in site visit preparation and execution by regulatory and accreditation agencies.
• Conducts internal auditing of compliance with regulatory and accreditation standards.
• Supports the implementation of the quality reporting infrastructure.
• Pursues methods to ensure receipt of data required for trending and reporting of various QI work plan metrics, performs adequate data/barrier analysis, develops improvement recommendations, and deploys actions as approved.
• Assists in activities to prioritize clinical and service improvement initiatives.
• Participates in various QI committees and work groups convened to improve process and/or health outcomes, and contributes meaningful detail, based on functional knowledge. Completes follow-up as assigned.
• Manages and monitors assigned quality studies.
• Investigates and incorporates national best practice interventions to effect greater rate increases.
• Ensures that documentation produced and/or processed complies with state regulations and/or accrediting body requirements.
• Ensures assigned contract/regulatory report content is accurate and that submission adheres to deadline.
• Performs other duties as assigned.

Want More Information?

Interested in hearing more about this great opportunity? Reach out to Marjorie Mora, Recruiting Consultant at marjorie@healthcaresupport.com for immediate consideration.

Salary

$30.00-35.00