Qi Nurse Specialist
3 weeks ago
**QI Nurse Specialist (Facility Site Review Nurse Auditor)**
**CalOptima**
**CalOptima Health** is seeking a highly motivated an experienced **QI Nurse Specialist** to join our team. The QI Nurse Specialist (Facility Site Review Nurse Auditor) will be responsible for performing Department of Health Care Services (DHCS), Facility Site Reviews (FSR) and Medical Record Review (MRR) in compliance with DHCS Medi-Cal Managed Care Division (MMCD). The incumbent will be responsible for auditing health network, CalOptima Health's direct provider offices and designated Healthcare Delivery Organizations (HDO's) to ensure safety, quality and physician compliance with local, state, federal and CalOptima Health's requirements. Additionally, the incumbent will conduct other focused site reviews, as requested by management.
**Position Information**:
- Department**:Quality Improvement**:
- Salary Grade**:M - $85,000 - $141,086**:
- Work Arrangement**:Community Worker**
**This position is located in the Community.***
**Duties & Responsibilities**:
- 80% - Audit Support
- Audits practitioner offices utilizing approved prescribed audit tools for FSR/MRR/ Physical Accessibility Review Survey (PARS).
- Assists practitioner offices and/or health networks for readiness to audit surveys.
- Provides pre-audit and/or post-audit educational sessions.
- Audits health care delivery organizations (skilled nursing facilities, dialysis centers, rehab, home health, etc.) as needed and scheduled, utilizing the appropriate audit tools.
- Documents accurately according to prescribed guidelines per audit tools.
- Maintains accurate and timely site audit files.
- Acts as liaison between provider sites and CalOptima Health to assess and communicate issues and improvement opportunities for the plan(s) of action and resolution(s). Performs follow-up audits/reviews as generated by initial outcome scoring on FSR/MRR to ensure Corrective Action Plans (CAPs) have been adequately implemented and develops CAPs as deemed necessary.- 15% - Organizational Support
- Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
- Assists the team in carrying out department responsibilities and collaborates with others to support short
- and long-term goals/priorities for the department. Provides support to internal/external staff and fosters an environment where customer needs (health network, practitioner, etc.) are the primary focus.- 5%
- Completes other projects and duties as assigned.
**Minimum Qualifications**:
- Bachelor's degree in health services, public health, business (with quantitative emphasis), nursing or related field required.
- 3 years of experience in patient care, health care or managed care setting required.
- 3 years of clinical experience in medical/surgical, ambulatory care, Independent Physician Association (IPA) or medical group environment required.
- 3 years of experience in quality management required.
- An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.
- Valid driver's license and vehicle or other approved means of transportation, an acceptable driving record and current auto insurance will be required for work away from the primary office 50% of the time or more.
**Preferred Qualifications**:
- Certification by health plan as Certified Site Reviewer.
Experience in a health care delivery system, including health plan, medical group or hospital management.
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**Required Licensure / Certifications**:
- Current, unrestricted Registered Nurse (RN) license to practice in the State of California required.
**Knowledge & Abilities**:
- Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds.
- Work independently and exercise sound judgment.
- Communicate clearly and concisely, both orally and in writing.
- Work a flexible schedule; available to participate in evening and weekend events.
- Organize, be analytical, problem-solve and possess project management skills.
- Work in a fast-paced environment and in an efficient manner.
- Manage multiple projects and identify opportunities for internal and external collaboration.
- Motivate and lead multi-program teams and external committees/coalitions.
**Physical Requirements (With or Without Accommodations)**:
- Ability to visually read information from computer screens, forms and other printed materials and information.
- Ability to speak (enunciate) clearly in conversation and general communication.
- Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.
- Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crou
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