(RN/LPN) Senior Quality Improvement Specialist

Job Description

Job Description

AltaStaff is a staffing agency currently looking for a Senior Quality Improvement Specialist (RN or LPN) to work with our Managed Care Client!

Pay Rate: $37.00 - $40.00 hourly

Schedule will be Monday-Friday, EST timezone but hours are flexible

**Candidates must be willing to travel in Michigan up to 50% of the time**

Summary: The Senior Quality Management Specialist works with the Quality Management team to implement, oversee, and maintain new and existing healthcare quality monitoring activities and programs; ensures quality monitoring audits and investigations are performed in accordance with prescribed quality standards; and provides direction and implementation of federal/state quality management compliance activities.

Responsibilities:

• Performs quality monitoring activities, including audits of medical record quality, services and service sites, health and safety, and follow-up of monitoring of placement settings.

• Implements key quality strategies that require a component of near real-time clinical decision-making. These activities may include initiation and management of interventions (e.g., improving patient safety); preparation and review of potential quality of care and critical incident cases; review of medical record documentation for credentialing and model of care oversight; and any other federal and state required quality activities.

• Supports the creation and ongoing revision of policies and procedures reflective of state requirements for all quality management functions, including quality monitoring audits, credentialing and recredentialing, quality of care concerns, and peer review.

• Monitors and ensures that key quality activities that involve clinical decision-making are completed on time and accurately in order to present results to key departmental management and other departments as needed.

• Adheres to written documentation and business practices (e.g., policies and procedures, desk-level procedures, manuals, and process flows) that explain the business requirements and how the unit operationalizes those requirements.

• Adheres to structure and processes for tracking and trending reportable incidents, quality of care events, member service concerns, and mortalities.

• Is well-versed in the requirements of the quality management program and day-to-day work processes to support compliance with state contract, policies, and program requirements.

• Ensures individual and systemic quality of care investigations are performed timely, accurately, and in accordance with state-based requirements.

Qualifications:

• Must have active, unrestricted RN or LPN license in Michigan

• Must have 3+ years of experience in healthcare

• 1+ year of experience in managed care

• Must have familiarity with Medicare Stars and HEDIS quality metrics

• Must have Driver's License and reliable transportation

Work Environment Requirements:

• Must be able to to lift at least 30lbs

• Must be able to stand or sit for prolonged periods (75% of the time)

• Private Secured Internet Connection

• Must confirm work environment is safe and secure for work in handling private and sensitive information.

• Constantly operates a computer and other office equipment

• Constantly works indoors in a secluded safe space

• Must have High-speed internet access 25 MBPS minimum; 50 MBPS minimum preferred

If you've applied and would like to view your application status, please visit:

AltaStaff is an Equal Employment Opportunity Employer. We provide equal employment opportunities to all qualified applicants for employment without regard to age, race, color, creed, religion, sex, marital status, national origin, ancestry, citizenship, disability, veteran status, sexual orientation, or any other protected status, in accordance with applicable federal, state, and local laws.

#RNCM1