Quality Improvement, RN (Hybrid with site visits)

About the role

The Quality Improvement, RN facilitates quality improvement initiatives across the continuum of care (acute care hospitals, skilled nursing facilities, hospice agencies, etc.) to enhance the overall quality of care delivered to members. This position is responsible for identifying, developing, coordinating, promoting, supporting, and implementing assigned clinical quality and/or service improvement projects and programs.

The role supports evidence-based practice integration, provider training/education, policy review/development, and regulatory/accreditation interpretation. The incumbent develops continuous and targeted activities to improve performance related to Centers for Medicare & Medicaid Services (CMS) Star Ratings, HEDIS, CAHPS, HOS, P4P, and other identified performance measures. This position provides direct support for multiple initiatives aimed at improving the quality and effectiveness of health care delivery and/or health care services.

The Quality Improvement, RN communicates with external partners, internal quality leaders, and stakeholders to ensure multi-disciplinary teams have the resources and information they need.

Responsibilities

• Facilitate quality improvement initiatives across the continuum of care
• Identify, develop, coordinate, promote, support, and implement clinical quality and service improvement projects
• Support evidence-based practice integration, provider training/education, policy review/development, and regulatory/accreditation interpretation
• Develop activities to improve performance related to CMS Star Ratings, HEDIS, CAHPS, HOS, P4P, and other performance measures
• Provide direct support for initiatives aimed at improving the quality and effectiveness of health care delivery
• Communicate with external partners, internal quality leaders, and stakeholders to ensure multi-disciplinary teams have needed resources
• Apply knowledge of continuous improvement tools and work process redesign

Requirements

• Minimum four (4) years of clinical/health care experience, including at least two (2) years performing quality improvement analysis or project coordination functions
• Bachelor’s degree in science or health/healthcare related field from an accredited institution (required)
• Master’s degree in science or health/healthcare related field from an accredited institution (preferred)
• Certified Professional of Healthcare Quality (CPHQ) or other recognized quality improvement certificate (required or obtained within one (1) year of hire, maintained through employment)
• Active, unrestricted, and unencumbered Registered Nurse (RN) license issued by the California BRN (required)

Qualifications

• Working knowledge of healthcare quality performance and measurement sets (CMS quality withhold, Managed Care Accountability Set, NCQA Quality Improvement Standards, HEDIS)
• Knowledge of advanced clinical processes and/or hospital operations
• Understanding of the local healthcare market, patient demographics, and plan-specific information
• Strong analytical and critical thinking skills
• Proficient in Microsoft Office applications, with emphasis on Excel and PowerPoint
• Effective communication skills (verbal, written, and listening) with ability to interact with key stakeholders
• Attention to detail
• Ability to apply facilitation techniques to quality improvement project teams
• Problem-solving, conflict management, and team collaboration skills
• Ability to read and interpret data
• Ability to manage and prioritize tasks, work efficiently under pressure, and meet deadlines in a fast-paced environment

Benefits

• Competitive salary
• State-of-the-art fitness center on-site
• Medical insurance with dental and vision coverage
• Life, short-term, and long-term disability options
• Career advancement opportunities and professional development
• Wellness programs promoting a healthy work-life balance
• Flexible Spending Account (Health Care/Childcare)
• CalPERS retirement
• 457(b) option with a contribution match
• Paid life insurance for employees
• Pet care insurance

Pay

$91,249.60 USD Annually - $120,910.40 USD Annually