Healthcare Careers

THE HEALTHCARE INITIATIVE

Where Talent Meets Opportunity

Quality Improvement Nurse Supervisor (Managed Care)

California

Position:

A progressive and growing Healthcare organization looking for a Nurse Supervisor: Quality improvement to oversee of quality improvement, grievances and appeals consistent with regulatory standards both federal and state as well as internally. Participates in HEDIS activities as required including but not limited to acting as clinical lead, performing overreads, and training on the HEDIS medical record review process.  Oversees root cause analysis investigations for patient care and provider trends.  The RN Supervisor will make recommendations and implements action plans based on their findings.  Attends all FSR state collaborative meetings and implements all DHCS/DMHC regulatory changes. Act as a liaison to statewide and community agencies to identify and resolve program issues. This position works closely with the Director of Quality Management.

Position and Department Information:

• Hybrid work environment: Remote/office
• Monday-Friday work schedule
• Oversees 10 staff members.
• Supervision: QI Nurses, Grievance Coordinators, Senior Appeals Nurses and Grievances and Appeals Nurses.
• Case types: Grievances, Appeals and PQI Processes.

Qualifications:

• Bachelor’s degree in nursing, required
• Unrestricted California Registered Nurse license, required.
• 3+ years clinical experience as a nurse in an acute care setting, required.
• 2+ years of recent experience working with MediCal, Medicare or other state or federally sponsored program, including grievances and appeals, required.
• 1+ year of progressive leadership experience, required.
• Experience participating in facility site reviews and other HEDIS, related activities, strongly preferred.
• Experience working with DHCS, CMHS and NCAQ, strongly preferred.
• Valid California driver license and reliable transportation, required.

Key Skill Set:

• Analytical
• Team Oriented
• Independent Thinker
• Effective communicator both written and verbal.

Location:

This location offers many outdoors areas to explore and enjoy while being centrally located to re-known universities, a wide variety of sporting events, a variety of museums and some of the best dining in the United States.

We look forward to an opportunity to speak to you. To apply or schedule a confidential phone conversation, please send your resume (MS WORD format preferred) to

alison@thi-search.com or call 720-735-9739