Registered Nurse RN Quality Improvement Specialist
Company: Maxim Government Services
Posted on: June 28, 2019
Academic/Faculty/Research opening in Raleigh, North Carolina. This
and other rn jobs brought to you by NursingJobCafe.com Maxim
Healthcare Services currently has an opening for a Quality
Improvement Specialist RN to work for a health plan in Raleigh, NC.
- A Fortune 200 Company
- Voted World's Most Admired Company
- Focuses exclusively on government-sponsored healthcare
- Full benefits available including 401k with company match and
- Paid time off starting with 18 days. Job summary:
- Supports the development and implementation of quality
improvement interventions and audits and assists in resolving
deficiencies impacting plan compliance to regulatory and
accreditation standards. Interfaces with a diverse range of
clinical and administrative professionals, resolves complex issues,
and performs data analytic and reporting activities. Key Duties and
- Monitors quality improvement initiatives including, but not
limited to, development and implementation of preventive health and
chronic disease outcome improvement interventions such as:
newsletter articles, member education and outreach interventions,
provider education, member outreach interventions, medical record
reviews, focus groups, and surveys.
- Monitors and investigates all quality of care and collaborates
with medical directors to determine impacts and next steps for
actions. Monitors provider quality complaints to identify trends
and educational opportunities for improvement.
- Analyzes, updates, and modifies procedures and processes to
continually improve QI operations.
- Collects and summarizes performance data and identifies
opportunities for improvement.
- Serves as knowledge expert for continuous quality improvement
activities, QIPS, PIPs and QIAs.
- Monitors and analyzes outcomes to ensure goals, objectives,
outcomes, accreditation and regulatory requirements are met.
- Participates in site visit preparation and execution by
regulatory and accreditation agencies (State agencies, CMS, AAAHC,
URAC, NCQA, EQRO).
- Conducts internal auditing of compliance with regulatory and
- Supports the implementation of the quality reporting
- Pursues methods to ensure receipt of data required for trending
and reporting of various QI work plan metrics, performs adequate
data/barrier analysis, develops improvement recommendations, and
deploys actions as approved.
- Assists in activities to prioritize clinical and service
- Participates in various QI committees and work groups convened
to improve process and/or health outcomes, and contributes
meaningful detail, based on functional knowledge. Completes
follow-up as assigned.
- Manages and monitors assigned quality studies.
- Investigates and incorporates national best practice
interventions to affect greater rate increases.
- Ensures that documentation produced and/or processed complies
with state regulations and/or accrediting body requirements.
- Ensures assigned contract/regulatory report content is accurate
and that submission adheres to deadline.
- Performs other duties as assigned. Additional Position
- Completes Licensed Health Care Risk Management certification
- Performs annual update on Plan Risk Management Program
- Coordinates the regular and systematic review of all potential
adverse incidents in accordance with state statute.
- Completes AHCA Code 15 Reports for confirmed adverse
- Submits an annual AHCA adverse incident summary report.
- Presents summary Requirements:
- Active, unrestricted North Carolina RN license, BSN
- 2+ years in Quality Improvement.
- 3+ years in Managed Care. For immediate consideration, please
call Chris, the recruiter, at or email a copy of your resume to
with your availability to speak over the phone. Keyphrases: medical
faculty jobs, medical research jobs, biostatistics faculty
Keywords: Maxim Government Services, Danville , Registered Nurse RN Quality Improvement Specialist, Healthcare , Raleigh, Virginia
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