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Quality Enhancement Nurse

2 months ago

Honolulu, Hawaii, United States AlohaCare Full time
Job Overview

Position Summary:

The Quality Improvement Nurse plays a crucial role in maintaining and elevating the standards of care within our organization. This position requires collaboration with various stakeholders, including administrators, healthcare staff, and service providers, to foster and uphold exceptional quality of care and service for our members.

Key Responsibilities:

  • Conduct thorough data analysis to identify trends and opportunities for improvement, as well as assess the effectiveness of implemented interventions.
  • Formulate and execute strategies aimed at enhancing member outcomes and overall care quality.
  • Ensure adherence to local, state, and federal regulations, along with compliance with accreditation standards.
  • Provide training and educational support to healthcare providers and staff regarding AlohaCare's Quality Improvement initiatives.
  • Assist members with quality improvement activities as necessary.
  • Facilitate the orientation and training of new employees within the Quality Improvement Department.
  • Support various quality improvement activities, including but not limited to:
    • Conducting audits
    • Reviewing medical records
    • Preparing and presenting reports on quality metrics and improvement initiatives
    • Developing policies and procedures
    • Participating in committees and workgroups
    • Implementing Clinical Practice Guidelines
    • Managing HEDIS and NCQA Accreditation processes
    • Addressing potential quality of care issues and adverse events
    • Overseeing performance improvement projects
    • Completing other assigned duties as required
  • Collaborate with interdisciplinary teams to design and implement quality improvement projects.
  • Support quality-related activities across internal departments, such as Credentialing and Health Services.
  • Maintain confidentiality of AlohaCare's sensitive information in accordance with organizational policies and applicable laws.
  • Perform additional job-related tasks as assigned by Quality Improvement leadership.

Qualifications:

  • Associate's degree in nursing.
  • A minimum of two years of clinical experience.
  • Proven ability to assess, evaluate, and interpret clinical information effectively.
  • Ability to work autonomously with minimal supervision.
  • Strong interpersonal skills to collaborate effectively with members, physicians, and other healthcare providers.
  • Excellent planning, organizational, analytical, and time management skills.
  • Clear verbal and written communication skills across departments and with members and providers.
  • Basic computer proficiency, data analysis skills, and familiarity with spreadsheet and database applications.
  • Intermediate PC skills, including proficiency in Microsoft Office software.
  • Exceptional written and verbal communication abilities.
  • Strong organizational skills with the capacity to manage multiple tasks simultaneously.
  • Knowledge of healthcare regulations and accreditation standards.

Licensure/Certification Requirements:

  • Current and unrestricted Registered Nurse (RN) license in the State of Hawaii.
  • Valid State of Hawaii Driver's License and access to a reliable, insured vehicle.

Preferred Qualifications:

  • At least three years of clinical experience, preferably in an acute care setting.
  • Familiarity with Quality Improvement/Quality Assurance principles and methodologies, as well as healthcare research methodologies.
  • Experience in a managed care environment is advantageous.

Working Conditions:

  • Frequent travel across all islands in the State of Hawaii may be required.
  • Prolonged periods of sitting, up to four hours, may be necessary.
  • Requires operation of a computer workstation, including keyboard and video display terminal.
  • Effective communication via telephone and within group settings is essential.
  • Occasional lifting of up to 20 pounds may be required.
  • Ability to work in a high-stress environment with multiple deadlines.