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Central California Alliance for Health · 2 months ago

Quality Improvement Nurse PQI (Temporary)

Mariposa County, California

Full-time

Hybrid

Mid Level

$50/hr - $57/hr

3+ years exp

Central California Alliance for Health is a regional non-profit health plan committed to providing accessible, quality health care. The Quality Improvement Nurse PQI is responsible for developing and managing healthcare strategies to improve member health outcomes and evaluate patient safety and quality issues.

GovernmentHealth CareHealth InsuranceHospital

No H1B

Responsibilities

Develops, manages, and measures a comprehensive healthcare strategy in alignment with Department of Health Care Services (DHCS) standards of care and in collaboration with internal stakeholders and network providers to promote best evidence-based practices and improve member health outcomes

Evaluates patient safety and quality issues and communicates findings to internal stakeholders, network providers and community partners

Qualification

Healthcare quality improvementProcess improvementManaged care knowledgeQuantitative analysisQualitative analysisNCQA HEDIS guidelinesCPT coding principlesICD coding principlesClinical nursing principlesHealthcare delivery systemsAudit participationResearchAnalysisReport preparationRegistered Nurse licenseBachelor's degree in Nursing

Required

Current, unrestricted license as a Registered Nurse issued by the State of California

Bachelor's degree in Nursing and a minimum of three years of experience as a Registered Nurse in acute care or primary care with an emphasis on preventative care (a Master's degree may substitute for two years of the required experience); or an equivalent combination of education and experience may be qualifying

Experience in process improvement, practice coaching, or health care quality improvement

Experience performing PQI activities

Working knowledge of managed care, the Medi-Cal program, and related policy

Working knowledge of the methods of conducting and interpreting quantitative and qualitative analysis

Some knowledge of NCQA HEDIS abstracting guidelines

Some knowledge of CPT and ICD coding principles

Knowledge of the principles and practices of clinical nursing

Knowledge of medical practice operations and healthcare delivery systems

Ability to participate in and support internal and external audits

Ability to identify issues, conduct research, gather and analyze information and data, reach logical and sound conclusions, and make recommendations for action

Ability to analyze information and data and prepare oral and written reports