Wellness Quality Assurance, Nurse Manager

Responsibilities

• Participate in the coordination and development of goals and outcomes using HEDIS specifications for Quality Improvement and Corrective Action Plans
• Review generic charts, and other population-based data or abstractions, required by HEDIS, or the quality improvement process
• Track and trend reported quality related issues
• Serve as a clinical liaison between the Fund and Providers on quality-of-care concerns (HEDIS and other Performance Measures)
• Review performance, evaluate effectiveness, analyze data, identify trends, and collaborate with business leads to recommend quality enhancements
• Monitor gaps in care for a variety of mental health and medical chronic conditions for provider groups and individual providers and address them
• Engage Fund Registered Nurses (RN), Health Educators (HE) and Social Workers (SW) in quality assurance projects, such as outreach to members with the gaps in care
• Supervise and provide clinical oversight of all the Wellness RNs and HEs activities
• Educate members regarding acute and chronic conditions and promote healthier lifestyle behaviors
• Participate in seasonal vaccination, and other types of testing, as needed
• Participate in Health Fairs, Screenings, and Outreach Events at New York City and outer borough locations, as needed
• Perform additional duties and projects as assigned by management

Qualifications

• Valid New York State Registered Nurse (RN) required; Bachelor’s degree in Nursing preferred
• Minimum of three (3) years of Quality Improvement experience, two (2) years of management experience and two (2) years nursing experience in ambulatory care, community health care or medical/surgical
• Strong experience in clinical assessment, patient education, motivational interviewing, critical thinking, independent decision-making, quality assurance and quality improvement processes
• Excellent nurse-physician communications skills
• Knowledge of Healthcare Effectiveness Data and Information Set (HEDIS), and National Committee for Quality Assurance (NCQA)
• Intermediate computer and digital literacy
• Basic skills in Microsoft Outlook, Word and Excel preferred
• Bilingual in Spanish preferred
• Valid NYS Driver’s license preferred with travel in New York Metropolitan area
• Ability to work flexible hours including evenings and weekends as needed