Clinical Quality Research Analyst

Job Responsibilities

• Performs quality and/or compliance audits to identify and address opportunities for improvement.
• Captures Process Improvement based upon audit results.
• Provides education and guidance on development of measures.
• Provides consulting support for quality and compliance audits.
• Serves as a resource for multidisciplinary workgroups.
• Uses research experience and data analysis as tools for identifying existing potential healthcare and service opportunities for improvement and can design solutions for identified problems.
• Identifies existing potential healthcare and service opportunities for improvement and assists in designing solutions for identified problems.
• Educates internal customers on Quality Processes.
• Presents and communicates audit results to appropriate parties; participates in rebuttal processes as applicable.
• Analyzes results for trends and identifies areas of non-compliance.

Job Qualifications

• Licenses: Registered Nurse (RN) with active license in the state of Tennessee or hold a license in the state of their residence if the state is participating in the Nurse Licensure Compact Law.
• Experience: 4 years - Managed care experience, or experience with regulatory or accrediting body requirements (i.e., URAC, NCQA, EQRO, and CMS) and Clinical Quality Improvement experience required.

Skills & Certifications

• Certification as a Professional in Healthcare Quality, Lean Six Sigma Certification, or equivalent certification required, or must be attained within 1 year of hire.
• Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles and accountability.
• Demonstrated presentation and team facilitation skills.
• Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint).
• Excellent oral and written communication skills.
• Strong analytical skills.