Quality Program Nurse, RN (Remote)

Overview What you can expect! Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience! Under the direction of the Manager, Quality Management Nurses, the Quality Program Nurse, RN (QPN) is responsible for the implementation of Quality Management policies, procedures, and activities. The QPN implements and monitors DHCS regulatory requirements related to Facility Site Review (FSR) and Medical Record Review (MRR) Policies. The Quality Program Nurse, RN partners with IEHP’s network providers to not only assess compliance, but to also support improvement efforts aimed at meeting these requirements. Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation. Additional Benefits Perks IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more. • Competitive salary • Telecommute schedule • CalPERS retirement • State of the art fitness center on-site • Medical Insurance with Dental and Vision • Life, short-term, and long-term disability options • Career advancement opportunities and professional development • Wellness programs that promote a healthy work-life balance • Flexible Spending Account – Health Care/Childcare • CalPERS retirement • 457(b) option with a contribution match • Paid life insurance for employees • Pet care insurance Key Responsibilities • Perform initial, periodic, and verification Site Review and Medical Record Surveys for assigned Primary Care Providers. Conduct other regulatory audits as assigned. • Review Primary Care Provider Corrective Action Plans (CAP) submissions and monitor CAP compliance. • Work collaboratively with assigned Primary Care Providers and office staff to help remediate areas of non-compliance • Perform focused audits as directed by IEHP Subcommittees. • Perform annual HEDIS data abstractions. • Monitor assigned PCPs for potential problem hours and document findings. • Review QM reports and CAP log on a weekly basis. Responsible for Provider compliance and follow up. • Attendance and participation in Quality Management Committee and/or Subcommittee meetings, as needed. • Attend Site Review and Medical Record Survey training, as mandated by DHCS, to maintain and become a Certified Site Reviewer. • Attendance and participation in Quality Management, Medical Services, and other inter-departmental staff meetings as indicated. • Attendance and participation in Quality Management Committee or Subcommittee meetings, as directed. • Perform any other duties as required to ensure Health Plan operations and department business needs are successful. Qualifications Education & Requirements • Three (3) or more years of any individual or combined experience in Quality Assurance, Utilization Management, Case Management, provider liaison duties, and/or clinical experience in a hospital/clinical setting required • Experience preferably in an HMO or Managed Care setting • Associate’s degree in Nursing from an accredited institution required • Bachelor’s degree in Nursing from an accredited institution preferred • Possession of valid Certified Site Reviewer (CSR) Certificate issued from DHCS or participating Medi-Cal Managed Health Plan Provider. If not a CSR, the candidate should be willing and able to get certified within one (1) year of hire • Possession of an Active, unrestricted, and unencumbered Registered Nurse (RN) license issued by the California BRN required. Valid State of California driver's license and valid automobile insurance Key Qualifications • Must have a valid California Driver’s license • Knowledgeable and understanding of Nursing principles & Evidence based practices. • Computer applications: spreadsheet, database, and word processing • Strong organizational, time-management, and critical thinking skills • Excellent written and verbal communication and interpersonal skills • Highly skilled in interpersonal communication, including conflict resolution • Ability to manage multiple projects with completing deadlines and changing priorities Start your journey towards a thriving future with IEHP and apply TODAY! Work Model Location Telecommute (All IEHP positions approved for telecommute work locations may periodically be required to report to IEHP’s main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership) Pay Range USD $91,249.60 - USD $120,910.40 /Yr. Apply tot his job Apply To this Job