Kern Family Health Care · 1 day ago
TMP Quality Performance RN I-Temporary
KHS Buck Owens Office, 2900 Buck Owens Blvd., Bakersfield, California, United States of America
Full-time
Onsite
Entry, Mid Level
2+ years expKern Family Health Care is dedicated to improving health status through integrated managed healthcare delivery. The Quality Performance RN I-Temporary role involves assisting in the implementation of quality performance initiatives, performing medical record reviews, and ensuring compliance with state and federal regulations.
Health CareHospitalNon Profit
Responsibilities
Assist in the implementation of the QP initiatives and functions
Performs QP activities related to State required Quality requirements
Serves as knowledge expert for KHS QP activities
May be required to achieve State certification through the California Department of Health Services as a facility site reviewer and conduct facility site reviews for credentialing and re-credentialing of practitioners and providers. Certification is provided through KHS
Performs and documents HEDIS or HEDIS-like medical record reviews to assess compliance with specific measures
Participates in problem identification, data analysis, conclusions, recommendations, and action plans
Monitors and analyzes outcomes to ensure goals, objectives, outcomes, and regulatory requirements are met
Assists in preparation of reports for committees
Assists in activities to prioritize QP initiatives
Ensures that documentation produced and/or processed complies with State and Federal regulations
Assists with training and orientation for new employees
Performs all job functions in a safe manner
Provides input in support of State and Federal requirements as it pertains to the mandated managed care accountability set (MCAS) measures
Maintains the confidentiality of records and reports for both KHS members and contracted providers
Performs in-depth medical records reviews as needed and is able to write a professional, clinical summary
Knowledge of acute care nursing principles, methods, and commonly used procedures
Knowledge of medical terminology, hospital routine; and commonly used medical equipment
Knowledge of acute hospital organizations and inter-relationships of various clinical and diagnostic services
Performs other job-related duties as required
Qualification
Required
Possession of a valid California Registered Nursing License and in good standing
Associate Degree in Nursing from an accredited institution or equivalent required
Ability to effectively evaluate medical records of hospital admissions regarding continuing stay necessity, appropriateness of setting, delivered care, use of ancillary services and discharge plans
Ability to assess and judge the clinical performance of physicians and other health professionals
Thorough knowledge of health care delivery systems
Knowledge of State and Federal managed care regulatory requirements
Ability to read, interpret and apply written regulations, guidelines and other materials
Strong analytical, assessment and problem-solving skills
Strong people skills, including the ability to establish and maintain effective working relationships with individuals at all levels both inside and outside of KHS
Ability to use tact and diplomacy to diffuse emotional situations
Effective oral and written communication skills, including the ability to effectively explain complex information and document according to standards
Intermediate skills in Word, Excel, PowerPoint, and Outlook, with basic ability to enter data into and navigate through a database
Ability to commit to and facilitate an atmosphere of collaboration and teamwork
Knowledge of provider documentation requirements and governmental regulations affecting reimbursement
Demonstrated ability to respect and maintain the confidentiality of all sensitive documents, records, discussions and other information generated in connection with activities conducted in, or related to, patient healthcare, KHS business or employee information
Self-directed, with proven ability to work independently with minimum supervision
Uses appropriate judgment and asks questions and seeks assistance appropriately
Demonstrated ability to multi-task and complete assignments on a timely basis
Strong attention to detail; works accurately and meets expected deadlines and target dates
Ability to communicate effectively with contracting physicians, other ancillary providers and internal departments
Compliant with KHS policies and procedures
Preferred
Certification in Quality Improvement/Assurance highly desired
Bachelor of science (BSN) Preferred
Two (2) years of RN experience in a direct patient care setting preferred
One (1) year experience in Utilization Management or QI/QP in a healthcare delivery or managed care setting desired
Company
Kern Family Health Care
Kern Health Systems, known as Kern Family Health Care, was established in 1993 as a managed care health plan, and is the largest health plan in Kern County.
501-1000 employees
H1B Sponsorship
Kern Family Health Care has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (2)
2023 (3)
2022 (2)
2021 (2)
2020 (1)
Funding
Current Stage
Late StageLeadership Team
Emily Duran
Chief Executive Officer
Alan Avery
Chief Operating Officer
Recent News
2025-01-07
Company data provided by crunchbase