POSITION SUMMARY/RESPONSIBILITIES
Coordinates and collaborates with Community First Health Plans, Inc. (Community First), various departments to ensure that contractual, regulatory, and accreditation requirements, including National Committee for Quality Assurance (NCQA) and Healthcare Effectiveness Data and Information Set (HEDIS) are met as it pertains to the Quality Management Department. Monitors Community First performance on various quality metrics and benchmarks them against state and federal standards. Provides ongoing management of data collection systems and the development of procedures for monitoring, validating, and reconciling data for accuracy. May serve as a leader/facilitator of process improvement efforts. Provides oversight of and performs functions of review, investigation, and analysis of member-level clinical care data and provider performance as it compares to standards of care.
EDUCATION/EXPERIENCE
Graduation from an accredited school of professional nursing is required. Bachelor's degree in nursing, clinical informatics, or other health care, or other health care related field is preferred. Five or more years of relevant healthcare experience is required. Experience in data analysis and preparation of quality improvement or related reports is preferred. Experience with Microsoft Office (Outlook, Word, Excel). Excellent communication and interpersonal skills are required. Quality Management certification such as CPHQ or CHCQM is preferred. Working knowledge of continuous process improvement principles and standard coding products is preferred.
LICENSURE
Current licensure as a Registered Nurse in the State of Texas is required.
Numbers & Facts
Location
San Antonio, TX
Skills
Analysis Skillsunmatched
Benchmarkingunmatched
Clinical Dataunmatched
Clinical Medicineunmatched
Clinical Nursingunmatched
Communication Skillsunmatched
Community Healthunmatched
Data Analysisunmatched
Data Collectionunmatched
Data Managementunmatched
Data Qualityunmatched
Health Informaticsunmatched
Health Planunmatched
Healthcareunmatched
Healthcare Effectiveness Data and Information Set (HEDIS)unmatched
Interpersonal Skillsunmatched
Microsoft Excelunmatched
Microsoft Officeunmatched
Microsoft Outlookunmatched
Microsoft Wordunmatched
National Committee for Quality Assurance (NCQA)unmatched
Nursing Credentialsunmatched
Nursing Informaticsunmatched
Nursing Managementunmatched
Performance Analysisunmatched
Procedure Developmentunmatched
Process Improvementunmatched
Quality Managementunmatched
Quality Metricsunmatched
Reconciliationunmatched
Regulationsunmatched
Standards of Careunmatched
Systems Administration/Managementunmatched
🎯
Be found by employers
5,500+ employers search our resume database daily. Add yours to get found by recruiters looking for candidates like you.
Level up your application
Professional resume templates
Browse dozens of recruiter approved resume templates, layouts and formats. Choose your favorite and make it your own in minutes.