Senior Quality Improvement Nurse (RN) - Facility Site Review - Central California Alliance for Health
Scotts Valley, CA
About the Job
We have an opportunity to join the Alliance as a Senior Quality Improvement Nurse (RN) - Facility Site Review in the Quality Improvement and Population Health Department.
WHAT YOU'LL BE RESPONSIBLE FOR
Reporting to the Clinical Safety Quality Manager, this position:
- Develops, manages, and measures a comprehensive healthcare strategy in alignment with Department of Health Care Services (DHCS) standards of care and in collaboration with internal stakeholders and network providers to promote evidence-based practices and improve member health outcomes
- Collaborates with the Quality Improvement and Population Health Department Team and other departments to evaluate and report observed and/or measured trends in individual and group provider performance
- Participates in local, regional, and state audits and initiatives to measure, analyze and improve member health outcomes
- Evaluates patient safety and quality issues and communicates findings to internal stakeholders, network providers, and community partners
- Trains and mentors Quality Improvement Nurses-Facility Site Review
ABOUT THE TEAM
We are comprehensive and address both quality and safety of medical and behavioral health care provided to our members.
WHAT YOU'LL NEED TO BE SUCCESSFUL
To read the full position description, and list of requirements click here.
- Knowledge of:
- Principles and practices of clinical nursing
- Managed care, the Medi-Cal program, and related policy
- Medical practice operations and healthcare delivery systems
- Principles and practices of healthcare quality improvement
- Proficiency with Windows based PC systems and Microsoft Word, Excel, PowerPoint, and Outlook
- Methods and techniques of research, analysis, and reporting
- Ability to:
- Evaluate medical records and other health care data
- Conduct and coordinate audits, analyze audit results, and make recommendations for action
- Identify issues, conduct research, gather and analyze information and data, reach logical and sound conclusions, and make recommendations for action
- Synthesize large amounts of data and develop actionable plans to address provider issues and respond to audits
- Interpret, apply, and explain policies, regulations, terms, and procedures
- Act as a FSR subject matter expert and provide guidance regarding the more complex FSR activities
- Education and Experience:
- Current, unrestricted license as a Registered Nurse issued by the State of California
- Current certification as a Certified Site Reviewer as defined by DHCS
- Possession and continued maintenance of Certified Master Trainer certification issued by DHCS within one year of hire
- Bachelor's degree and a minimum of five years of experience as a Registered Nurse which included a minimum of three years of acute care or primary care experience with an emphasis on preventative care and a minimum of two years of experience in Quality Improvement (a Master's degree may substitute for two years of the required experience); or an equivalent combination of education and experience may be qualifying.
OTHER INFORMATION
- We are in a hybrid work environment and we anticipate that the interview process will take place remotely via Microsoft Teams.
- While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected.
- In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process.
The full compensation range for this position is listed by location below.
The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferrable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location).
OUR BENEFITS
Available for all regular Alliance employees working more than 30 hours per week. Some benefits are available on a pro-rated basis for part-time employees. These benefits are unavailable to temporary employees while on an assignment with the Alliance.
- Medical, Dental and Vision Plans
- Ample Paid Time Off
- 12 Paid Holidays per year
- 401(a) Retirement Plan
- 457 Deferred Compensation Plan
- Robust Health and Wellness Program
- Onsite EV Charging Stations
ABOUT US
We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us.
Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve members in Mariposa, Merced, Monterey, San Benito and Santa Cruz counties. To learn more about us, take a look at our Fact Sheet.
The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer
At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.