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Coordinator Quality Management, RN
Date: Aug 23, 2010
Location: San Antonio, TX, US
Coordinator Quality Management, RN
Job ID: 2010-11803
# Positions: 1
Location: US-TX-San Antonio
Search Category: Nursing
Type: Regular Full-Time (30+ hours)
Posted Date: 7/23/2010
More information about this job:
Overview:
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. This position is open in Austin and San Antonio. Bi-Lingual Spanish preferred.
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 AMERIGROUP 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.
Qualifications:
EDUCATION AND EXPERIENCE:
Education:
Required:
- Bachelor's degree or equivalent experience required
- Associates degree in nursing or related fiel
Experience:
- 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
- Valid Driver's License and clean driving record
Knowledge and Skills:
- Computer literate including word processing, spreadsheets and database management skills.
- Excellent verbal and written communication skills.
- Strong decision making skills. ' Demonstrates organizational skills.
- Ability to work self directed and in work groups.
- Ability to interact with all relevant components of the health care system.
- Appreciation of cultural diversity and sensitivity towards target population.
- Bi-Lingual Spanish Highly Preferred
PHYSICAL REQUIREMENTS: 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 a computer.
- Must be able to operate a telephone
Job ID: 2010-11803
# Positions: 1
Location: US-TX-San Antonio
Search Category: Nursing
Type: Regular Full-Time (30+ hours)
Posted Date: 7/23/2010
More information about this job:
Overview:
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. This position is open in Austin and San Antonio. Bi-Lingual Spanish preferred.
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 AMERIGROUP 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.
Qualifications:
EDUCATION AND EXPERIENCE:
Education:
Required:
- Bachelor's degree or equivalent experience required
- Associates degree in nursing or related fiel
Experience:
- 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
- Valid Driver's License and clean driving record
Knowledge and Skills:
- Computer literate including word processing, spreadsheets and database management skills.
- Excellent verbal and written communication skills.
- Strong decision making skills. ' Demonstrates organizational skills.
- Ability to work self directed and in work groups.
- Ability to interact with all relevant components of the health care system.
- Appreciation of cultural diversity and sensitivity towards target population.
- Bi-Lingual Spanish Highly Preferred
PHYSICAL REQUIREMENTS: 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 a computer.
- Must be able to operate a telephone
Nearest Major Market: San Antonio
Job Segments: Bilingual, Compliance, Database, Finance, Financial Sales, Healthcare, Law, Legal, Management, Manager, Nursing, Quality, Quality Manager, Registered Nurse, RFP, Risk Management, Sales, Technology
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