QI Nurse Specialist Job

LVN OR RN, FULL- TIME needed for A CONTRACT opportunity with Yoh's client located in Irving, Texas

THE BIG PICTURE:

- RESPONSIBLE FOR DEVELOPING, ORGANIZING, COLLECTING, COORDINATING, PREPARING AND PRESENTING RESULTS OF QUALITY IMPROVEMENT STUDIES AND PROJECTS ACTIVITIES TO MONITOR, EVALUATE AND CONTINUOUSLY IMPROVE THE QUALITY OF HEALTHCARE SERVICES PROVIDED TO MEMBERAND INPATIENT CASE MANAGEENT HOSPITAL EXPERIENCE IS REQUIRED. THIS WILL BE A LONG TERM CONTRACT
- TRAVEL WILL BE LOCAL IN HOUSTON, RARELY WILL TRAVEL OUT OF TOWN, TO OBTAIN CHARTS OR SITE VISITS- WILL BE EXPENSED STANDARD BUSINESS HOURS ON SITE M-F 8-5 BUT WILLING TO BE FLEXIBLE COMBINATION OF PHONE AND IN PERSON INTERVIEWS WILL TAKE PLACE CPHQ CERT

WHAT YOU'LL BE DOING:

- Collaborates with the Quality Improvement department staff in the development of quality improvement studies, initiatives and projects to improve the health care of members.
- PLANS AND COORDINATES THE COLLECTION, EVALUATION AND DISSEMINATION OF QUALITY IMPROVEMENT DATA FOR QUALITY INITIATIVES, STUDIES AND PROJECTS TO COMPLY WITH REGULATORY REQUIREMENTS AND ACCREDITATION STANDARDS.
- PREPARES REPORTS AND ANALYSES TO EVALUATE PERFORMANCE WITH STANDARDS FROM A VARIETY OF SOURCES SUCH AS AND NOT LIMITED TO: MATERIALS, DOCUMENTS, MEDICAL CHARTS, PROVIDER OFFICES, AND/OR FACILITIES.
- PERFORMS WITH QUALITATIVE AND QUANTITATIVE ANALYSIS TO IDENTIFY SIGNIFICANT AND PROBLEMATIC CLINICAL ISSUES AND CONCERNS, DEVELOPMENT OF IMPROVEMENT PLANS AND MEASUREMENT TO ASSESS IMPACT OF ACTIONS.
- PARTICIPATES IN NCQA ACCREDITATION AND REGULATORY AUDIT PREPAREDNESS AND MAINTAINS ACTIVITIES INCLUDING PREPARING REPORTS, NARRATIVES, GRAPHS, CHARTS, ETC. AS NEEDED FOR EXTERNAL AUDITS AND SURVEYS.
- PARTICIPATES IN AND FACILITATES QUALITY IMPROVEMENT PROGRAM COMMITTEES, AS ASSIGNED, INCLUDING PREPARING MATERIALS, MINUTES AND TRACKING ACTION ITEMS FOR COMMITTEE REVIEW.
- DEVELOPS AND MAINTAINS QUALITY IMPROVEMENT DEPARTMENT POLICIES AND PROCEDURES, MATERIALS AND REPORTS IN ACCORDANCE WITH STATE, FEDERAL, AND NCQA AND MOLINA REQUIREMENTS. STATE PLAN/DEPARTMENT SPECIFIC DUTIES AND RESPONSIBILITIES
- PERFORMS AUDITS OF MATERIALS AND MEDICAL RECORDS TO DEMONSTRATE COMPLIANCE WITH CONTRACTUAL OBLIGATIONS, IDENTIFY OPPORTUNITIES FOR IMPROVEMENT, AND TO VALIDATE MEDICAL RECORD-KEEPING PRACTICES FOR CREDENTIALING AND RECREDENTIALING PURPOSES.

WHAT YOU NEED TO BRING TO THE TABLE:

- IDENTIFIES APPROPRIATE BENEFITS, ELIGIBILITY, AND EXPECTED LENGTH OF STAY FOR MEMBERS REQUESTING TREATMENTS AND/OR PROCEDURES.
- PARTICIPATES IN INTERDEPARTMENTAL INTEGRATION AND COLLABORATION TO ENHANCE THE CONTINUITY OF CARE FOR MEMBERS INCLUDING BEHAVIORAL HEALTH AND LONG TERM CARE.
- MAINTAINS DEPARTMENT PRODUCTIVITY AND QUALITY MEASURES.
- ATTENDS REGULAR STAFF MEETINGS. ASSISTS WITH MENTORING OF NEW TEAM MEMBERS. COMPLETES ASSIGNED WORK PLAN OBJECTIVES AND PROJECTS ON A TIMELY BASIS.
- IN DEPTH KNOWLEDGE OF INTERQUAL AND OTHER REFERENCES FOR LENGTH OF STAY AND MEDICAL NECESSITY DETERMINATIONS. EXPERIENCE WITH NCQA.
- ABILITY TO TAKE INITIATIVE AND SEE TASKS TO COMPLETION. COMPUTER LITERATE (MICROSOFT OFFICE PRODUCTS).
- EXCELLENT VERBAL AND WRITTEN COMMUNICATION SKILLS.
- PREFERABLY HOSPITAL NURSING, UTILIZATION MANAGEMENT, AND/OR CASE MANAGEMENT. REQUIRED LICENSURE/CERTIFICATION: ACTIVE, UNRESTRICTED STATE NURSING (RN, LVN, LPN) LICENSE IN GOOD STANDING HIGH .

GET HIRED, APPLY NOW!

RECRUITER: JENNIFER YERKES

Yoh, a DayJ2W: PROF

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SFSF: HC