Quality Program Nurse, RN (Remote with field work)

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Requirements Summary

The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

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Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!

Under the direction of the Manager, Quality Management Nurses, Quality Program Nurses (QPN) are responsible for the implementation of Quality Management policies, procedures, and activities. QPN’s enforce DHCS regulatory requirements as pertaining to Facility Site Review (FSR) and Medical Record Review (MRR) criteria.

Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

What We Offer

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IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more.

Competitive salary
State of the art fitness center on-site
Medical Insurance with Dental and Vision
Life, short-term, and long-term disability options
Career advancement opportunities and professional development
Wellness programs that promote a healthy work-life balance
Flexible Spending Account – Health Care/Childcare
CalPERS retirement
457(b) option with a contribution match
Paid life insurance for employees
Pet care insurance

Responsibilities

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→Perform initial, periodic, and verification Site Review and Medical Record Surveys for assigned Primary Care Providers. Conduct other regulatory audits as assigned.

→Review Primary Care Provider Corrective Action Plans (CAP) submissions and monitor CAP compliance.

→Perform focused audits as directed by IEHP Subcommittees.

→Perform annual HEDIS data abstractions.

→Monitor assigned PCPs for potential problem hours and document findings.

→Review QM reports and CAP log on a weekly basis. Responsible for Provider compliance and follow up.

→Attendance and participation in Quality Management Committee and/or Subcommittee meetings, as needed.

→Attend Site Review and Medical Record Survey training, as mandated by DHCS, to maintain and become a Certified Site Reviewer.

→Attendance and participation in Quality Management, Medical Services, and other inter-departmental staff meetings as indicated.

→Attendance and participation in Quality Management Committee or Subcommittee meetings, as directed.

→Any other duties as required to ensure Plan operations are successful.

Requirements

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Three (3) or more years of any individual or combined experience in Quality Assurance, Utilization Management, Case Management, provider liaison duties, and/or clinical experience in a hospital/clinical setting
Experience preferably in an HMO or Managed Care setting
Associate’s degree in Nursing from an accredited institution required
Bachelor’s degree in Nursing from an accredited institution preferred
Possession of valid Certified Site Reviewer Certificate issued from DHCS or participating Medi-Cal Managed Health Plan Provider
If not a CSR, the candidate should be willing and able to get certified within 6 months of hire
Possession of an Active, unrestricted, and unencumbered Registered Nurse (RN) license issued by the California BRN required
Valid State of California driver's license and valid automobile insurance

Knowledgeable and understanding of nursing principles & evidence based practices
Computer applications: spreadsheet, database, and word processing.
Strong organizational, time-management, and critical thinking skills
Excellent written and verbal communication and interpersonal skills.
Highly skilled in interpersonal communication, including conflict resolution.
Minimal to moderate physical activity; may include standing, bending, sitting for long periods of time and repetitive motion
Ability to manage multiple projects with completing deadlines and changing priorities
Automobile travel within the Inland Empire
May periodically be required to report to IEHP’s main campus for in-person meetings or for other business needs as determined by IEHP leadership

Telecommute (All IEHP positions approved for telecommute work locations may periodically be required to report to IEHP’s main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership)

Automobile travel within the Inland Empire

May periodically be required to report to IEHP’s main campus for in-person meetings or for other business needs as determined by IEHP leadership

USD $91,249.60 - USD $120,910.40 /Yr.