Nurse Quality Management
On-siteBoerne, Texas, United States
Job Summary
Coordinate and collaborate with Community First Health Plans, Inc. to ensure contractual, regulatory, and accreditation requirements, including NCQA and HEDIS, are met. Monitor performance on various quality metrics against state and federal standards while providing ongoing management of data collection systems. Develop procedures for monitoring, validating, and reconciling data for accuracy, and serve as a leader or facilitator of process improvement efforts. Provide oversight of and perform functions regarding the review, investigation, and analysis of member-level clinical care data and provider performance compared to standards of care. Requires current Texas RN licensure, a Bachelor's degree in nursing or related field, and five years of healthcare experience.
Required Qualifications
- Graduation from an accredited school of professional nursing
- Bachelor's degree in nursing, clinical informatics, or other health care, or other health care related field
- Five or more years of relevant healthcare experience
- Current licensure as a Registered Nurse in the State of Texas
- Excellent communication and interpersonal skills
Desired Qualifications
- Experience in data analysis and preparation of quality improvement or related reports
- Experience with Microsoft Office (Outlook, Word, Excel)
- Quality Management certification such as CPHQ or CHCQM
- Working knowledge of continuous process improvement principles and standard coding products
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