Description: Job Profile Summary Position Purpose: Analyze, develop, implement and monitor clinical quality improvement initiatives to achieve healthy outcomes.
Education/Experience: Bachelor s degree in nursing preferred. 2+ years clinical, quality management or healthcare related experience. At least one year experience in quality function in a healthcare setting.
License/Certification: LPN, LVN, RN, PA, or LCSW license preferred. Utilization management certification preferred. Certified Professional in Healthcare Quality preferred.
Responsibilities Perform duties and functions to comply with quality improvement programs according to state requirements. Support Quality Assurance Performance Improvement work plan/initiatives. Schedule and assist with committee and sub-committee preparation. Assist in investigation and resolution of member quality of care complaints. Audit medical records and monitor performance measures for health care risk management, sentinel events and trends.
For PA H&W only: Responsible for overseeing reporting and outcome measurement and HEDIS data collection, serving as point person between the Department and the Department s EQR contractor."
Custom Fields: Name: Shortlisting Date Value: None
Name: Which Health Plan, programs or functions will this work support? Value: SilverSummit Healthplan