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HEDIS RN for Medicare/Dual Eligible Populations - New York City
Job ID 2013-21590
# Positions 1
Location US-NY-New York
Search Category Nursing
Type Regular Full-Time (30+ hours)
Posted Date 1/7/2013
Additional Locations ..
More information about this job:
The Coordinator Quality Management RN – Plan is responsible for developing, coordinating, implementing, and evaluating the continuous quality improvement activities for assigned populations(s) according to the established Quality management program. In collaboration with and under the direction of either Plan or Corporate Quality leadership, this position will assist in defining opportunities for improvement and collaborate with various internal and external participants to improve member experience, satisfaction, and sustainable outcomes. This position will also provide education in the area of quality improvement to departments, providers, and the community and assist in ensuring compliance with regulatory and accrediting organizations.
This position is located in New York, NY.
1. Design and implement quality improvement studies including selection of valid and reliable indicators, coordination of monitoring and evaluation activities, and medical record reviews.
2. Analyze data and prepare concise, accurate and meaningful quality management reports in accordance with QM principles.
3. Actively collaborate with Plan and/or Corporate teams to improve sustainable member outcomes.
4. Coordinate plan level resolution of member complaints/grievances in assigned population.
5. Educate providers and other organizational departments in the improvement of member outcomes and satisfaction for assigned population(s).
6. Assist in the preparation of information for RFIs, RFPS, and other QM related meetings and initiatives.
7. Conduct audits for all nationally delegated vendors and provider office visits to facilitate ongoing education and improvement for assigned populations.
8. Participate in provider office clinic days, health fairs, and community events to ensure maximum member benefit, improved data collection, and display a clinical presence.
9. Complete all other duties as assigned.
EDUCATION AND EXPERIENCE
• Associate’s degree in nursing or related field.
• Bachelor’s degree (or equivalent) in nursing or related field.
Years and Type of Experience
• 2 years experience in quality improvement, risk management and/or utilization review in a managed care setting.
• Knowledge of local and national quality management and regulatory standards, including NCQA and HEDIS reporting.
Certifications or Licensures
• Current professional RN license.
• Bilingual capabilities (Spanish or other)
• Proficiency in company supported software (i.e., Excel, Outlook, Word)
• Good verbal and interpersonal skills.
• Good telephonic skills.
• Professional demeanor.
• Appreciation of cultural diversity and sensitivity toward populations served.
• Organizational skills and ability to multi-task.
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
• Must be able to travel independently as needed and adhere to Amerigroup travel policies and procedures.
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