RN Quality Improvement Coordinator

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.