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Health Plan Quality Management Registered Nurse - Quality Assurance

Company: Ascension Seton Northwest
Location: Austin
Posted on: November 26, 2022

Job Description:

Health Plan Quality Management Registered NurseDetails Department: Ascension Care Management Insurance Schedule: Monday -Friday, Days Location: Texas - Fully Remote Benefits Paid time off (PTO) Various health insurance options & wellness plans Retirement benefits including employer match plans Long-term & short-term disability Employee assistance programs (EAP) Parental leave & adoption assistance Tuition reimbursement Ways to give back to your community *Please note, benefits and benefits eligibility can vary by position, exclusions may apply for some roles (for example: PRN, Short-Term Option, etc.). Connect with your Talent Advisor today for additional specifics. Responsibilities Ascension is currently seeking a RN Coordinator - Clinical Programs to support the quality improvement programs of DCHP and coordinates the quality management efforts including development, implementation, data collection, and analysis. The preferred candidate will reside in Texas and have quality management experience working in a managed care organization. She/he should also be knowledgeable in the Texas Medicaid line of business Star and Chip. Responsbilities include: Plan, design, implement, and maintain a comprehensive program of continuous quality improvement (CQI). Assists in educating new staff, providers about the quality improvement (QI) systems and requirements. Knowledge of quality improvement principles, practices and procedures. Must have thorough knowledge or Performance Improvement Projects (PIPs) and is able to apply that knowledge in PIP writing development, update, and analysis of data in PIPs. Coordinates the activities of the Quality Improvement Committee and Provider Advisory Committee / Medical Advisory Committee (PAC MAC) May review medical records and other documentation to ensure quality care Assist in preparing the annual QI evaluation report and plan/program documents. Have a working knowledge of the Uniform Managed Care Manage Manual, Uniform Managed Care Contract, URAC/NCQA, and apply concepts to day to day tasks. Must have working knowledge with the following quality programs: Alternative Payment Models, Pay 4 Quality, and Texas Health Steps program is able to apply their knowledge in the implementation, monitoring, and calculations required within each programs. Requirements Licensure / Certification / Registration: Required Credential(s): --- BLS Provider obtained prior to hire date or job transfer date. --- Registered Nurse obtained prior to hire date or job transfer date. Preferred Credential(s): --- Advanced Life Support. Education: Diploma from an accredited school/college of nursing required. Work Experience: None required. Additional Preferences Experience: BSN or MSN preferred Current Texas resident strongly preferred Minimum of 1 year of Quality Improvement experience in a Managed Care Organization or Health Plan preferred Abilities: Ability to establish and maintain effective working relationships, coordinate activities among departments within the organization and groups outside the organization. Demonstrate a combination of maturity, judgment, experience and confidence to practice independently in a variety of challenging situations. Express ideas clearly and concisely, logically and coherently. Exercise balanced judgment in evaluating situations and making decisions. Ability to respond effectively to inquiries and complaints internally and externally. Ability to learn and adapt. Demonstrate awareness, sensitivity and appreciation of all culture, traditions, customs and socioeconomic needs. Ability to be resourceful and calm when there are multiple initiatives to implement and deadlines deliverables are due and especially as we continue to build out our processes Why Join Our Team Ascension associates are key to our commitment of transforming healthcare and providing care to all, especially those most in need. Join us and help us drive impact through reimagining how we can deliver a people-centered healthcare experience and creating the solutions to do it. Explore career opportunities across our ministry locations and within our corporate headquarters. Ascension is a leading non-profit, faith-based national health system made up of over 150,000 associates and 2,600 sites of care, including more than 140 hospitals and 40 senior living communities in 19 states. Our Mission, Vision and Values encompass everything we do at Ascension. Every associate is empowered to give back, volunteer and make a positive impact in their community. Ascension careers are more than jobs; they are opportunities to enhance your life and the lives of the people around you. Equal Employment Opportunity Employer Ascension is an equal opportunity employer (EEO) and affords equal opportunity to all associates and applicants without regard to race, color, religion, national origin, citizenship, gender identity, sexual orientation, age, physical or mental disability, veteran status, genetic data, or other legally protected status. For further information regarding your EEO rights, click on the following link to the "EEO is the Law" poster: http://www.dol.gov/ofccp/regs/compliance/posters/pdf/eeopost.pdf EEO is the Law Poster Supplement Please note that Ascension will make an offer of employment only to individuals who have applied for a position using our official application. Be on alert for possible fraudulent offers of employment. Ascension will not solicit money or banking information from applicants. This employer participates in the Electronic Employment Verification Program. Please click the E-Verify link below for more information. E-Verify

Keywords: Ascension Seton Northwest, Austin , Health Plan Quality Management Registered Nurse - Quality Assurance, Executive , Austin, Texas

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