• Address: Houston, TX 77204 (map)
• Date Posted: 10/29/09
• Job Type: Full-time

CompanyNurse Resolutions
Job Title RN - Registered Nurse - Quality Improvement - Managed Care
Job Code
Job Location Houston, Texas 77081: .
Description RN - Registered Nurse - Quality Improvement - Managed Care
Category:Nurse: Assistant (CNA)
Position Is For:Regular Full Time Employment
Position Posted By:A Recruiting Firm
Posting Expires:November 13, 2009
Facility Description:In the past decade the demand for nurse professionals has increased significantly, with no indication that this need will subside in the near future. Nurse Resolutions is a specialized recruiting firm formed with the sole objective of placing quality nurse professionals in permanent positions within non-clinical and clinical settings across the country.




Our firm partners with a variety of healthcare organizations and health systems. We successfully source candidates for hospitals, insurance carriers, managed care companies, long-term care facilities, medical research organizations, pharmacies and outpatient clinics. Nurse Resolutions strives to be an extension of your Human Resource department. We take great pride in building ongoing business relationships with our clients. Our team identifies and secures talent for your organization, acting as your back office support throughout the recruitment process. Our goal is to resolve all of your permanent nursing issues.




We recognize that a company s success is strongly correlated with the talent that it attracts. Our firm is comprised of experienced Account Executives and Placement Consultants whose background and experience in sourcing specialized candidates has been fine tuned by years of experience. Our firm utilizes a unique platform, combining a variety of resources with proven success to create value for client and candidate every time. Our recruiting strategies save time and effort while consistently ensuring highly-skilled professionals to the companies we partner with.


Location:Houston, Texas 77081

: .
City Description:We are a recruitment firm that specializes in the full time permanent placement of Registered Nurses NATIONWIDE !!!
Position Description:The Quality Improvement Specialist supports the development and implementation of quality improvement measures and audits, and assists in improving quality processes throughout the enterprise through coordinating and engaging in activities to resolve deficiencies. The Quality Improvement Specialist monitors, performs, or manages quality improvement processes including those supporting compliance to regulatory and/or accreditation standards. Position will collect, analyze and report on a variety of data to assess the quality and appropriateness of care and treatment of members and to provide oversight in the allocation and utilization of program resources.

Responsibilities:


Assists in the education of providers in the importance of following the documentation guidelines that have been established in accordance with state, federal and accreditation requirements.


Collaborate in the implementation, monitoring and reassessment of quality improvement plans.


Maintain working knowledge of CMS and HIPAA regulations standards as applicable to Health Plan


Work with Medical Management staff and provider partners to develop appropriate action plans to improve quality of delivery of health care.


Maintain goals and objectives of the Quality Improvement Program, Quality Management Work plan and Company s strategic initiative.


Monitors cases in data base to identify trends, emerging issues and presents these to quality committees.


Conducts focused examinations of conditions regarding correction, and develop a precise definition of the problem.




Coordinate with providers to communicate and ensure adherence to healthcare quality management guidelines.



Maintain all documentation related to delegation oversight including schedules and calendars for oversight activities, and electronic and paper documentation of audits performed


Develop a delegation oversight team including appropriately qualified auditors across the enterprise. Educate and train audit team members to procedures, tools, and regulatory/compliance requirements.


Leading the Quality Improvement Committee(s) for expansion markets in new and existing health plans including establishing membership, schedules for meetings, agenda s, and educating membership regarding collecting and analyzing reporting metrics. This function may require travel to markets within and outside the Houston market area.


Perform and/or oversee Quality Assurance audits for Medical Management/ Health Services business units that includes, but not limited to: interrater reliability evaluation, Chapter 13 compliance, care management activities, productivity and other elements as determined by the Chief Medical Officer, Medical Directors and executive leadership.


Utilize standard evaluation tools for audits and provides reports to business owners and to Quality Improvement Committee(s) of audit results.


Assist in development of improvement plans with department/unit managers and supervisors in response to identified deficiencies.



2 yrs in health plan operations or health plan quality improvement. Medicare Advantage health plan experience a plus. Experience in performing delegation oversight will be advantageous Skills: Oral/written communications, data entry, MS Office, Software skills


Problem solving skills Research and Analytic skills RN degree required 4 year degree preferred None The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Identify to the health plan through the analysis process a summary of issues and / or policies that have potential to negatively impact clinical outcomes and / or the delivery of quality healthcare.

Benefits:Full Benefits!!!
Contact:


Andrew Goldstein

(andrew@nurseresolutions.com)

Title: Senior National Account Executive

Phone: 561-715-5328

Toll Free: 888.411.2228

FAX: 407-557-2270





Contact:Andrew Goldstein(andrew@nurseresolutions.com) Title: Senior National Account Executive Phone: 561-715-5328 Toll Free: 888.411.2228 FAX: 407-557-2270