Quality Improvement RN

• 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 (State agencies, CMS, AAAHC, URAC, NCQA,EQRO).

• 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