Sr. Clinical Quality Registered Nurse

Company Name:
Koch Davis
The Clinical Quality Nurse participates in on site quality external audits such as NCQA, AAHC & EQRO and prepares audits of required documents. Provides recommendations for quality improvement studies including selection of valid and reliable indicators and coordinates monitoring and evaluation activities upon select implementation. Analyzes data and prepares concise, accurate and meaningful quality management reports in accordance with company procedures; defines opportunities for improvement through trend analysis and communicates information appropriately. Assist in implementation and monitoring of quality studies including, but not limited to the development and implementation of preventive health and chronic disease outcomes improvement interventions such as newsletter article, member education and outreach interventions, provider education and outreach interventions, medical record review, focus studies and surveys. Performs monthly, quarterly, annual and ad-hoc medial record reviews such as HEDIS and CPG compliance; conducts quality of care investigations and using criteria closes case appropriately or refer to Medical Director for further review; prepares cases for peer review committee.
Requirements
Require a minimum of 2 years experience in quality improvement in a managed care setting. Quality management in a hospital setting will considered. Knowledge of local and national quality management and regulatory standards, including NCQA and HEDIS reporting required. Current unrestricted RN license in the state of NJ required and CPHQ preferred. Thirty-five percent local travels are required to providers within company network. Must have computer skills; MS Word, Outlook, Excel and knowledge of Facets, Maccess a plus.
Education
BA/BS degree in Nursing preferred.
Client
One of the leading health benefits companies that working to transform health care with trusted and caring solutions.

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