The Quality Improvement (QI) Nurse will support the Quality Improvement Program, assisting the health plan to successfully achieve organizational objectives for quality and patient safety. This position will be responsible for core clinical functions within the Quality Improvement department, including quality reviews, reporting, and performance improvement activities.
Monday-Friday 8:00am-5:00pm
$40.00-$45.00/hour
Responsibilities:
Work closely with other departments of the Health Plan, the Ql team, and Chief Medical Officer to achieve the goals of the QI department.
Lead the investigation, processing, and reporting of identified potential quality issues (PQIs) following the Plan's procedures and timelines.
Track and trend PQI outcomes for the purpose of QI reporting and prioritization of actions/interventions.
Annually review and edit relevant QI policies and procedures per APL updates, regulatory requirements, and/or required process changes.
Conduct facility site reviews (FSR) according to DHCS site survey requirements, and maintain the FSR database.
Ensure that clinical and service PQI standards and FSR processes are compliant with state and federal requirements.
Participate in the annual HEDIS project, including medical record abstraction and over-reads to determine compliance with HEDIS measures and optimize performance outcomes.
Participate in departmental quality improvement activities and audits, including but not limited to, medical record review, performance improvement projects (PIPs), PDSA processes, and CQI activities.
Lead, facilitate and/or participate in relevant committees and work groups; prepare reports, data or other materials for committee presentation.
Complete project-related communications, including job aides, member/physician communications, work plans/action plans, graphical analyses, and agendas/minutes, as applicable.
Research best practices, national and regional benchmarks, and industry standards in order to help promulgate quality outcomes for the Plan.
Demonstrate strong leadership skills and work ethic, with the ability to foster teamwork and work effectively with multidisciplinary teams, multi-task, and adapt quickly to change.
Perform all other duties as assigned.
Requirements:
Bachelor's Degree in Nursing or similar
2+ years of clinical experience in Quality Improvement, Risk Management or Accreditation
Prior experience with Potential Quality Issues (PQIs)
Analytical and problem solving skills
Strong communication skills
