QI Nurse
Location: Tustin California
Description: MemorialCare is currently seeking to employ QI Nurse right now, this vacancy will be placed in California. Detailed specification about this vacancy opportunity please read the description below. Job Details:
About us:
MemorialCare Medical Foundation (MCMF) works closely with physicians and other health care professionals to provide best practice medicine to improve the health and well b! eing of individuals, families and our communities.
Job Responsibilities :
1. Conduct Quality Improvement audits/surveys, requested by the Manager of Quality Improvement, QI Team Lead, Director of Medical Management, QI Committee, Medical Director and HMO’s, as a way to recognize and/or identify potential quality issues or trends.
2. Investigate patient complaints/grievances received from patients, family, staff, employer groups and HMOs. Author response letters to HMO.
3. Prepare correspondence to patients advising of their non-compliance to medical advice or inappropriate behavior. If deemed necessary, begin the disenrollment process.
4. Conduct medical record audit of patients who are referred to Behavioral Health ensuring appropriate communication is established and ongoing, between the primary care physician and behavioral health provider. Summarize and analyze all findings.
5. Conduct medical record audits of MCMG physicians as req! uired by NCQA/HMOs. Summarize findings into report which is su! bmitted to QI RN representative, to support the departments’ requirements.
6. Attend various interdepartmental meetings, as the QI RN representative, to support the departments’ requirements.
7. Establish and maintain strong and cooperative working relationship with Medical Director, Director of Medical Management, Manager of QI, QI Team Lead, Risk Management, and Patient Relations.
8. Document patient information and grievance resolution in a concise, accurate, and timely manner.
9. Conduct monthly mortality, analyze and submit a summary of findings/trends to QI committee and Medical Director
10. Perform any additional/miscellaneous duties (not inclusive of job description) as requested by the management team within the scope of knowledge/ability.
Qualifications/Skills:
Qualified candidate must excel in interpersonal communication and customer service and be able to work both independently and as part of a team. They must excel i! n organization and attention to details and follow through. Additionally, they must have the ability to problem solve to logical conclusion and demonstrate initiative and responsibility. Must be able to effectively and clearly communicate (written and verbal) in English. Knowledge of NCQA standards, Managed Care products, Medicare, and Medi-Cal and MS Office required. Internet computer familiarity a must.
Experience:
Minimum of 3 years experience in Managed Care, preferably Quality Improvement.
Education:
High school graduate or equivalent. BSN or Bachelor’s Degree in a health-related field preferred.
Must have a current California RN license.
MCMF2742
Req Number: 314416
- .
If you were eligible to this vacancy, please email us your resume, with salary requirements and a resume to MemorialCare.
If you interested on this vacancy just click on the Apply button, you will be redirected to the official website
This vacancy starts available on: Sun, 15 Sep 2013 13:40:02 GMT