Quality Management Coordinator - RN or Registered Nurse

Summary/Position Objectives: 

Performs assessments of the quality of care and service rendered by MCP providers.  Assists in the development and implementation of improvement action plans designed to improve individual and network wide performance.  Participates in other quality improvement and accreditation activities.

 

 Responsibilities:  Essential Functions: 

 

1.  Conducts retrospective and concurrent review of medical records for potential quality of care and risk issues.

 

2.  Schedules and performs clinical ambulatory medical record audits, compiles results, and provides feedback to providers.

 

3.  Provides education and works with providers to develop improvement action plans aimed at increasing compliance with MCP standards of care and medical record documentation.

 

4.  Performs data entry and analysis of QM findings.

 

5.  Performs data collection for QI studies and activities.

 

6.  Participates in accreditation activities including data collection, assessment, and report writing.

 

7.  Participates in the development of QI monitors, studies, and tracking mechanisms.

 

8.  Maintains confidentiality of all member-specific and provider-specific data related to the Quality Management Program.

 

9.  Works in a manner that is not disruptive to peers, supervisors and subordinates.

10.  Performs other duties, assignments and responsibilities as assigned or required.

 

 

 Secondary Functions: 

 

?  Works in a manner that is not disruptive to peers, supervisors and/or subordinates.

?  Must maintain regular and acceptable attendance at such level as is determined in the employer?s sole discretion.

?  Must be available and willing to work such days and hours as the employer determines are necessary or desirable to meet its business needs.

?  Must be available and willing to travel to such locations and with such frequency as the employer determines is necessary or desirable to meet its business needs. (If travel required.)

 Knowledge and Skills:

?  Intermediate to advanced math skills working with percents, ratios, working knowledge of statistics

?  Intermediate to advanced math skills working with percents, ratios, working knowledge of statistics

?  Excellent analytical skills

 Education and Work Experience:

?  R.N. license/BSN or related field

?  Minimum of three years experience in a clinical setting, with at least one year within quality management.

?  Knowledge of applicable laws, rules and regulations pertaining to quality management, utilization management or risk management.

?  Managed care experience

 

Work Environment Qualifications:

?  Normal Office Environment

?  Ability to be mobile.

?  Knowledge and demonstrated proficiency with computer applications:  word processing, spreadsheet, data base

?  Requires travel within the State

?  Must have car with valid personal insurance