Senior Quality Nurse

23 hours ago

Albuquerque NM United States American Health Quality Association Full time

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.

The Sr. Clinical Quality Consultant (CQC) RN will drive consistency, efficient processes and share best practices, in a collaborative effort with the provider and large or complex groups, designed to facilitate a minimum 4 STAR quality performance.
The Sr CQC will be provider facing and participate in quality improvement initiatives, attend monthly or joint operating committee meetings, and develop recommendations for quality improvement. This position is responsible for quality performance in their assigned region and will work collaboratively with the market team and their leadership in a matrix relationship.

Primary Responsibilities:

  • Develop business plans to motivate providers to improve STARS measure performance
  • Provide analytical interpretation and STARS/HEDIS performance summaries to provider groups
  • Be the subject matter expert for all STARS-related activities within their assigned territory working within a matrix relationship
  • Participate and present in weekly, Monthly, Bi-monthly, Quarterly and/or Annual business Review meetings related to STAR activities which summarize provider performance
  • Analyze and evaluate provider structure and characteristics, including EMR utilization, office operations, and personnel to identify the most effective approaches and strategies to improve STARS measure performance
  • Assist in developing STARS/HEDIS presentation materials for provider performance meetings

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

  • Registered Nurse within NM and/or a compact state. In lieu of RN license, Licensed Practice Nurse (LPN) with 5+ years of experience in HEDIS/STAR programs acceptable
  • 4+ years of healthcare experience
  • 2+ years of experience in provider-facing interactions
  • Experience and proficiency using Microsoft Office applications, including Outlook, Word, PowerPoint, and Excel spreadsheets
  • Ability to review clinical data and provide recommendations for improvement
  • Valid NM Driver’s license and ability to travel 75% locally

Preferred Qualifications:

  • 2+ years of experience in HEDIS/STARS, preferably in a clinical quality consultant role
  • 2+ years of data analysis and/or quality chart review and abstraction
  • Billing and CPT coding experience
  • Medicare and/or Managed Care experience

Physical & Mental Requirements:

  • Ability to lift up to 10 pounds
  • Ability to push or pull heavy objects
  • Ability to sit for extended periods of time
  • Ability to stand for extended periods of time
  • Ability to use fine motor skills to operate office equipment and/or machinery
  • Ability to properly drive and operate a vehicle
  • Ability to receive and comprehend instructions verbally and/or in writing
  • Ability to use logical reasoning for simple and complex problem solving
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