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RN - Quality Management-Las Vegas Job Details

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Company:  Nurse Resolutions
Job Code:  1441
Categories:  Skilled Nursing / Nursing Home (SNF)
Job Role:  Other
Country:  United States
Region/Province:  Nevada (NV)
City:  Las Vegas-Paradise
Job Description:  JOB SUMMARY: The Coordinator Quality Management RN - Plan is responsible in conjunction with management for developing, coordinating, implementing, and evaluating the continuous quality improvement activities throughout the company according to the established Quality Management program.  In collaboration with and under the direction management, the Coordinator Quality Management RN - Plan establishes indicators for monitoring and evaluating the full spectrum of care and services provided to members for quality, appropriateness, continuous improvement and satisfaction.  The Coordinator Quality Management RN - Plan provides education in the area of quality management to all departments and assists in ensuring compliance with regulatory and accrediting organizations.

PRIMARY RESPONSIBILITIES:
1. Designs and implements quality improvement studies including selection of valid and reliable indicators and coordinates monitoring and evaluation activities 2. Analyzes data and prepares concise, accurate and meaningful quality management reports in accordance with Company procedures.
3. Actively participates in intradepartmental quality management improvement teams as appointed.
4. Coordinates resolution of high level complaints.
5. Educates Health Plan associates about the QM process.
6. Assists in defining opportunities for improvement identified through analysis of trends and communicates these appropriately.
7. Assists in the preparation for the Quality Improvement Council and other QM related committee meetings.
8. Implements, analyzes and evaluates the Company-wide inter-rater reliability program.
9. Prepares QM department responses for RFIs and RFPs.
10. Responsible for maintaining quality management documents, case files and correspondence in an organized, confidential and secure manner.
11. Conducts, as appropriate, oversight audits for all nationally delegated vendors.
12. Develops and maintains ancillary vendor audit tools.
13. Communicates significant findings, including potential risk management issues to the AVP Quality Management as indicated in a timely manner.
14. Assists with coordinating HEDIS Improvement Activities.
15. Assists with coordinating Member Satisfaction Improvement activities.
16. Other duties as requested or assigned.

JOB REQUIREMENTS:
Education and Experience:
• Bachelor’s degree or equivalent experience required
• Associates degree in nursing or related field
• 2-3 years experience in quality improvement, risk management and/or utilization review in a managed care setting.
• Knowledge of local and national QM and regulatory standards preferred, including NCQA and HEDIS reporting.

Certification and Licensure:
• Current professional licensure – RN required
• CPHQ preferred
 

CONTACT:
Jason Edwards

888.411.2228 x 200 - Phone
407.982.7508 - Fax
Post Date:  05/24/2012
Apply Here

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