Quality Improvement Rn Jobs in New Jersey (NOW HIRING)

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Daily Responsibilities: 

Manages and monitors quality improvement initiatives including, but not limited to, development and implementation of preventive health and chronic disease outcome improvement interventions such as: newsletter articles, member education and outreach interventions, provider education, member outreach interventions, medical record reviews, focus groups, and surveys.

Analyzes, updates, and modifies procedures and processes to continually improve QI operations.

Collects and summarizes performance data, identify opportunities for improvement, and present findings to Quality Improvement Committees.

Leads and facilitates quality improvement teams in the development of QIPs, PIPs and QIAs

Serves as knowledge expert for continuous quality improvement activities.

Monitors and analyzes outcomes to ensure goals, objectives, outcomes, accreditation and regulatory requirements are met.

Participates in site visit preparation and execution by regulatory and accreditation agencies (State agencies, CMS, AAAHC, URAC, NCQA,EQRO).

Conducts internal auditing of compliance with regulatory and accreditation standards.-

Supports the implementation of the quality reporting infrastructure.

Pursues methods to ensure receipt of data required for trending and reporting of various QI work plan metrics, performs adequate data/barrier analysis, develops improvement recommendations, and deploys actions as approved.

Assists in activities to prioritize clinical and service improvement initiatives.

Participates in various QI committees and work groups convened to improve process and/or health outcomes, and contributes meaningful detail, based on functional knowledge. Completes follow-up as assigned.

Manages and monitors assigned quality studies.

Investigates and incorporates national best practice interventions to effect greater rate increases.---Ensures that documentation produced and/or processed complies with state regulations and/or accrediting body requirements.

Ensures assigned contract/regulatory report content is accurate and that submission adheres to dead

Must be a licensed RN 

3-5 years of Managed Care experience/Chart Review

Knowledge of compliance, accreditation, service or quality improvement

Knowledge of HEDIS

Knowledge of federal and state regulations

Experience with Medicaid and Medicare

Medical record review experience

Experience with patient assessment skills typical of nursing experience providing care for patients with various types of medical/surgical diagnoses

Ability to effectively present information and respond to questions from families, members, and providers Intermediate

Ability to create, review and interpret treatment plans Intermediate

Ability to identify basic problems and procedural irregularities, collect data, establish facts, and draw valid conclusions Intermediate

Want More Information? 

Interested in hearing more about this great opportunity? Reach out to Maria Ana Viar at (312) 445 8005  for immediate consideration. Interviews are being held immediately and you can get an offer ASAP!