Nurse Manager Quality Improvement for MCO

Quality Improvement Program Assistant

General Summary of Position: Responsible for assisting with the implementation, integration, and operational direction of the QI program within MedStar Family Choice (MSFC), MedStar's managed care organization that provides health coverage to people who qualify for Medicaid. The role involves organizing and directing the activities of Quality Improvement Services. This includes but is not limited to monitoring MSFC, participating provider processes and outcomes, overseeing the preparation and response to QLARANT audits, acting as the liaison between QI and other departments, and assisting the Medical Director with any State reports and meetings. As a hybrid role, the associate would be required to work onsite 3 days a week and two days from home. Office hours are generally 8:30 am to 5 pm; however, flexibility is required for morning/ late afternoon meetings with upper management or leadership. We recruit, retain, and advance associates with diverse backgrounds, skills, and talents equitably at all levels.

Primary Duties and Responsibilities:

• Assists with the development of department goals objectives policies procedures quality and safety standards and performance and productivity standards in collaboration with the Director. Ensures compliance with policies and procedures and governmental and accreditation regulations.
• Acts as a liaison between IS and the clinical team to identify workflow / system issues and resolutions. Uses technology to enhance decision making and effectiveness.
• Assists staff members with setting personal and educational goals and objectives to enhance their professional development. Develops and implements education programs to coordinate staff development and training needs both for software and clinical training issues.
• Assists with organizing the agenda and actively participates in QI/UM Committee meetings other departmental meetings and State meetings as directed. Oversees the preparation and distribution of agendas and minutes for committee meetings.
• Assists with the development of the annual QA plan and QA appraisal.
• Coordinates with the Medical Director and supervises the preparation of the annual audits; i.e. Delmarva HEDIS. Acts as the lead QI contact for these audits.
• Demonstrates skill and flexibility in providing coverage for staff.
• Identifies and directs new studies using conclusion recommendation action and evaluation formula.
• Leads staff meetings workgroups etc. as assigned. Addresses issues impacting MSFC with community agencies and providers. Delivers updated information back to QI staff. Provides ongoing individual coaching and support to staff and acts as a resource for the QI department. Meets regularly with department members to enhance communication and facilitate implementation and progress towards program objectives.
• Maintains current knowledge about and acts in accordance with procedures regarding member confidentiality and principles of consent.
• Maintains current knowledge of benefits claims and enrollment issues.
• Performs other duties as assigned.
• Prepares and analyzes special reports pertaining to all MedStar Family Choice's participating providers as directed by the Medical Director and the AVP of Care Management. Maintains centralized files for these studies.
• Provides first line response to quality issues. Follows the established protocol for reporting any quality issues identified.
• Selects trains orients and assigns department staff. Assists with the development of performance standards evaluates performance and conducts performance management planning. Initiates or makes recommendations for personnel actions. Maintains ongoing communication with subordinates to review progress provide feedback discuss new developments and exchange information.
• Supervises and provides oversight to delegated entities and reports findings to the Quality Improvement Council. Evaluates the annual plans appraisals quarterly reports claims and other issues as they arise. Develops and monitors Corrective Action Plans as necessary.
• Supervises coordinates and assists with the collection and interpretation of data on MedStar Family Choice's provider network for HEDIS medical record audits and quality issues. Accesses encounter data from vendors to obtain patient information.
• Works closely with all departments to gather information for monthly quarterly and yearly reports.
• Participates in meetings and on committees and represents the department and hospital in community outreach efforts. Participates in multi-disciplinary quality and service improvement teams.

Minimal Qualifications:

• Bachelor's degree in healthcare field required or
• Associate's degree in related field with relevant experience required or
• Bachelor's degree in Nursing (BSN) preferred

Experience:

• 3-4 years Quality improvement experience in an outpatient setting required
• 1-2 years supervisory experience preferred

Licenses and Certifications:

• RN - Registered Nurse - State Licensure and/or Compact State Licensure Valid RN license in the local area serving (State of Maryland or District of Columbia); Upon Hire preferred or
• Certification in a healthcare-related field, such as certification in healthcare quality (CPHQ), upon hire, preferred

Knowledge Skills and Abilities:

• Effective verbal and written communication skills.
• Ability to follow verbal and written instructions.
• Proficient with Microsoft Office applications especially Word Excel and PowerPoint.
• Ability to enter and retrieve information using a PC.
• Working knowledge of various computer software applications.
• Knowledge of current trends in health care delivery and population management.
• Knowledge of NCQA HEDIS InterQual and local regulatory guidelines preferred.

This position has a hiring range of USD $82,617.00 - USD $157,352.00 /Yr.