QI Nurse Specialist (PACE)
Location: Orange California
Description: CalOptima is currently seeking to employ QI Nurse Specialist (PACE) right now, this position will be placed in California. For detail informations about this position opportunity kindly read the description below. Under the general direction of the CalOptima PACE Medical Director, the QI Nurse Specialist develops and implements the quality improvement program for CalOptima PACE. This include! s annual review and update of the quality improvement plan, development and implementation of program-wide and center-specific quality indicators, data management, education and training of program staff around quality improvement, preparation of routine and special reports, and coordination of improvement efforts arising from monitoring activities. Manages the PACE health plan’s clinical grievance review process, including investigation of all quality reviews for potential quality of care concerns and quality of service and access issues, including collection and analysis of appropriate data. Ensures grievances/complaints are processed in accordance with applicable state and federal regulations, compliance standards, and policies and procedures.
Position Responsibilities
Conduct an annual review of the quality improvement program for CalOptima PACE and update plans as appropriate. Prepare routine and special reports of quality improvement activities and! performance.
Conduct ongoing analysis/assessment of ! operational performance for continuous process improvements, improved efficiency, and improved participant satisfaction.
Coordinate the development and implementation of program-wide and center-specific quality indicators.
Responsible for making timely reports to regulatory bodies as required under state and federal laws and regulations, including unusual incidences and sentinel event reporting.
Oversee data management for QI activities including the coordination of collection, entry, analysis and assessment of data; utilizes findings and trends to improve policies and procedures.
Perform investigation, fact-gathering, and follow-up for participant and/or caregiver grievances and appeals related to program services; prepare quarterly reports on grievances and appeals to PACE leadership.
Lead staff for organizing and preparing department staff for regulatory audits.
Perform investigations of unusual occurrences/events and! assesses criticality of events.
Assist with writing quality assurance policies and procedures.
Assist with selecting specific topics for review in support of quality improvement.
Compile statistical data and write narrative reports and presentations that summarize quality assurance findings and recommendations to PACE and CalOptima leadership.
Coordinate with national initiatives in PACE quality management including the development of the accreditation program, CMS’ CQI program, National PACE Association quality initiatives and technical assistance for developing sites.
Plan and oversee education for CalOptima staff on QAPI activities and techniques.
Assist in interface between consumers and program management for quality-related complaints.
Coordinate with PACE network providers to obtain relevant information in support of CalOptima PACE QI activities and requirements.
Attend and support the Quality! Assurance Committee of the CalOptima Board of Directors on PACE-relate! d matters. Alongside the PACE Medical Director, represents the PACE program within applicable CalOptima quality improvement committees.
Maintain and support a culture of compliance, ethics, and integrity.
Maintain knowledge of policies and procedures and perform in accordance with applicable regulatory requirements, external laws, and accreditation standards as they relate to business & clinical risk management.
Medical Records oversight and training.
Other projects and duties as assigned.
Required Skills
Work independently and as an effective member of a team.
Establish and maintain effective interpersonal relationships with all levels of staff, other programs, agencies, members, providers and the general public.
Communicate effectively, both verbally and in writing, with individuals from varying cultural and their backgrounds.
Prepare concise and clear reports.
Identify pertinent pol! icy issues; develop strategies, solutions and procedures.
Organize and track numerous and diverse activities, timelines and issues.
Motivate and lead various participants at all levels in the organization.
Effectively use computer to process appropriate data and information and prepare reports.
Required Experience
Experience & Education
Relevant Bachelor’s degree, such as Health Care Administration, Health Services, Public Health, Business (with quantitative emphasis), Nursing, or other related field.
Master’s degree desired.
Minimum 2 years experience working in healthcare quality improvement.
Current RN or LVN license to practice in the state of California is required.
Experience with statistical packages and analysis, including presenting findings.
CPHQ certification preferred.
Knowledge of
Techniques of project management, quality, and research method! s.
Culture and needs of the socially and ethnically diverse po! pulation CalOptima serves.
Principles and practices of health care, health care systems, and managed care.
Statistical analysis.
Medicare and Medi-Cal benefits and regulations.
State and Federal reporting requirements for health plans or programs.
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If you were eligible to this position, please email us your resume, with salary requirements and a resume to CalOptima.
If you interested on this position just click on the Apply button, you will be redirected to the official website
This position starts available on: Fri, 16 Aug 2013 07:58:37 GMT