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Quality Improvement Nurse Reviewer

Yoh Staffing Solutions San Francisco ,CA
  • Posted: over a month ago
  • $100,000 Yearly
  • Full-Time
Job Description

Quality Improvement Nurse Reviewer (RN) needed for a permanent opportunity with Yoh’s client located in San Francisco, CA

Top Skills You Should Possess:

  • Quality Improvement Experience in Managed Care or related setting required
  • HEDIS Experience

What You’ll Be Doing:

  • Responsible for project management of quality initiatives to improve performance across all lines of business and reports into the QI Director
  • The scope of quality includes NCQA and URAC, CAHPS, HEDIS reporting, STAR ratings, HOS reporting, Pay for Performance, clinical gaps, adherence to QI standards and all respective interventions
  • Shares responsibilities with Director of Clinical Services and credentialing staff for on-site visits to physician offices and audits activities and responsibilities related to QI as well as other clinical quality initiatives
  • Ensures organization maintains performance standards that are in compliance with state, federal and other regulatory bodies by developing, implementing, and effectively managing and evaluating departmental personnel, work processes, performance standards and quality improvement initiatives
  • Perform other duties as required  

What You Need to Bring to the Table:

  • Active California RN license
  • Bachelors Degree in Nursing or Healthcare Administration or related strongly preferred
  • Minimum of two-three (2-3) years of Quality Improvement Experience in a Managed Care or related setting
  • Previous HEDIS experience is a big plus
  • Understanding of Managed Care Delivery systems, operations, and HMO regulations
  • Must have excellent communication skills as position requires this role to be a link between organization and providers
  • Must be okay with minimal local travel
  • Ability to make quick decisions, work with team members, and have a go-getter attitude
  • Proficient with Computer and Microsoft applications

What are you waiting for?  Apply Now!

Recruiter:  Andrew Price 

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Yoh, a Day & Zimmermann company, is an Equal Opportunity Employer, M/F/D/V. Click here to contact us if you are an individual with a disability and require accommodation in the application process.

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Yoh Staffing Solutions

Address

San Francisco, CA
USA

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