Quality Improvement Nurse 8/12/2016

Alignment Healthcare Orange, CA

Company
Alignment Healthcare
Job Classification
Full Time
Company Ref #
28754951
AJE Ref #
575866792
Location
Orange, CA
Job Type
Regular

JOB DESCRIPTION

APPLY
The Quality Improvement Nurse, under the direction of the Director of Quality, is responsible for: 1) clinical oversight of the Special Needs Population (SNP) Model of Care and Case Management (CM) programs; 2) participating in accreditation/certification activities; and 3) supporting other quality activities.

GENERAL DUTIES/RESPONSIBILITIES:

(May include but are not limited to)

*

Assures that workflows, policies, procedures, regulatory and accreditation standards are implemented, adhered to and met for the SNP and CM programs.
*

Oversees implementation of new information systems serving the SNP and CM areas.
*

Oversees / assists in the SNP and CM delegation process.
*

Ensures SNP Quality Improvements Projects (QIPs) are prepared and submitted per guidelines, as well as monitors and evaluates each QIP for desired outcomes;
*

Conducts other activities such as inter-rater reliability studies, chart reviews, data collection, program effectiveness and comparative studies.
*

Provides required reports / special projects as requested.
*

Offers input and assistance with development of internal and external education and training programs for quality programs and metrics.
*

Ensures that potential quality of care issues are addressed and resolved timely.
*

Assists various departments with annual quality related projects (internal evaluation, compliance plans, HEDIS, Stars, Satisfaction Surveys, etc.).
*

Reviews, evaluates and develops policies, procedures, protocols and processes related to the organization's QI projects and programs.
*

Collaborates with the Information Technology Department to create usable outcomes data.
*

Collects, evaluates, and analyzes clinical, functional and program data for patterns or trends in care delivery and reports findings to management.
*

Maintains confidentiality of information between and among health care professionals.
*

Other duties as requested or assigned.

SUPERVISORY RESPONSIBILITIES:

None

MINIMUM REQUIREMENTS:

*

At least 2 years' experience with Medicaid, Medicare, and/or SNP.
*

Experience in managing or establishing a SNP plan preferred.
*

A minimum of five years of relevant professional experience.
*

Knowledge of Medicare Managed Care Plans, NCQA and HEDIS.
*

Knowledgeable with CMS guidelines and regulations.
*

Experience with the application of clinical criteria (i.e., Milliman, Interqual, Apollo, CMS National and Local Coverage Determinations, etc.)

EDUCATION/LICENSURE:

*

RN with clinical experience in Care Management.
*

Current, Active and Unrestricted California Registered Nursing license; CPHQ or ABQAURP, or Six Sigma certification preferred.
*

Minimum Associate's degree, Bachelor's degreepreferred.

OTHER SKILLS:

*

Personal computer experience should include working with Microsoft Word, Excel, PowerPoint and Outlook at the intermediate level at a minimum, as well as Visio, SharePoint.
*

Bilingual (English/Spanish) preferred
*

Ability to travel domestically (15-20%)

SKILLS AND ABILITIES:

*

Language Skills: Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors.
*

Mathematical Skills: Ability to perform mathematical calculations and calculate simple statistics correctly.
*

Reasoning Skills: Ability to prioritize multiple tasks; advanced problem-solving; ability to use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement and manage appropriate resolution.
*

Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.
*

Report Analysis Skills: Comprehend and analyze statistical reports.

Must be multi-task oriented and good with time management, well organized, and be able to work well under stringent timelines.