Quality Management Nurse (RN Preferred or LVN/LPN with Quality experience may be considered)
*****MUST BE LICENSED IN CALIFORNIA*****
Alignment Healthcare is a consumer-centric platform delivering customized health care in the United States to seniors and those who need it most, the chronically ill and frail, through its Medicare Advantage plans. Alignment Healthcare provides partners and patients with customized care and service where they need it and when they need it, including clinical coordination, risk management and technology facilitation. Alignment Healthcare offers health plan options through Alignment Health Plan, and also partners with select health plans to help deliver better benefits at lower costs.
By becoming a part of the Alignment Healthcare team, you will provide Medicare enrolled consumers the quality of care they truly need and deserve. We believe that great work comes from people who are inspired to be their best. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment community.
Position Summary:
The Quality Management Nurse is responsible for measuring and evaluating adherence to clinical processes, participating in accreditation/certification activities, and supporting other quality activities. The Quality Management Nurse reports to the Senior Manager of Quality Management.
General Duties/Responsibilities (May include but are not limited to):
a. Performing internal clinical program auditing, analysis and feedback as needed
b. Investigating potential quality of care issues that may affect the quality or safety of the health of members
c. Conducting chart review, data collection, program effectiveness and comparative studies
d. Assisting with annual quality related projects such as Chronic Condition Improvement Projects, internal evaluation, compliance plans, or Satisfaction Surveys
e. Evaluating reports for continued compliance with clinical quality requirements
f. Ensuring workflows, policies, procedures, regulatory and accreditation standards are implemented and maintain compliance for clinical programs
g. Other duties as requested or assigned
Minimum Requirements:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Minimum Experience:
a. Minimum 2-3 years Quality Management, Quality Improvement or Process Improvement Experience
b. Strong critical thinking and nursing judgment experience
c. Managed Care knowledge or experience
d. Maintain confidentiality of information between, and among, health care professionals
e. Knowledge of CMS guidelines, regulations, NCQA® and HEDIS®
f. Familiar with Special Needs Plan (SNP) programs
Education/Licensure:
a. Active, unrestricted State License for Registered Nurse (RN) preferred but a Licensed Vocational/Practical Nurse (LVN/LPN) in good standing with Quality experience may be considered
b. Associated Degree or bachelor’s degree in nursing, public health administration, or health related field preferred or an equivalent combination of education and experience which would provide the required knowledge, skills, and abilities
Other:
a. Excellent organizational skills with the ability to manage multiple priorities
b. Attention to detail with analytical and problem-solving capabilities
c. Ability to take initiative and see tasks to completion
d. Computer skills and experience with Microsoft Office Products
e. Excellent verbal and written communication skills
f. Problem solving skill sets and analytical ability
g. Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers
h. Experience with the Continuous Quality Improvement Process
Work Environment:
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions
Essential Physical Functions:
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. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions
a. While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms
b. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus
Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran.
If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact Alignment Healthcare.
Job Type: Full-time
Pay: $90,000.00 - $100,000.00 per year
Benefits:
Medical specialties:
Standard shift:
Weekly schedule:
Application Question(s):
Experience:
Work Location: Remote
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