RN Quality Improvement
Kern Family Health Care, 2900 Buck Owens Blvd., Bakersfield, California, United States of America Req #1514
We appreciate your interest in our organization and assure you that we are sincerely interested in your qualifications. A clear understanding of your background and work history will help us potentially place you in a position that meets your objectives and those of the organization. Qualified applicants are considered for positions without regard to race, color, religion, sex (including pregnancy, childbirth and breastfeeding, or any related medical conditions), national origin, ancestry, age, marital or veteran status, sexual orientation, gender identity, genetic information, gender expression, military status, or the presence of a non-job related medical condition or disability (mental or physical).
**Remote to start, then relocate to Bakersfield post Covid
Under the direction of the Director of Quality Improvement, the QI Nurse will assist in clinical activities related to monitoring, assessing and improving performance in ambulatory and inpatient health care delivery or health care related services to KFHC membership. The QI Nurse will assist in the implementation of the KFHC QI Plan and may lead quality improvement projects, perform facility site reviews, coordinate facility site review activities, conduct review of potential quality of care issues, perform special medical record reviews, or perform medical record reviews for validation of compliance with required managed care accountability measures.
- This position is responsible for assigned Quality Improvement functions for a Knox-Keene
- licensed health maintenance organization (HMO) and functions in a lead capacity for QI activities.
- Assist in the implementation of the QI Plan and Program.
- Performs QI activities related to State required quality studies and managed care accountability measures.
- Conducts facility site reviews for credentialing and re-credentialing of practitioners and providers.
- Completes medical record reviews to validate compliance with State managed care accountability measures.
- Prepares and reports physician specific findings to the Director of Quality Improvement for physician profiling.
- Assists in problem identification, data analysis, conclusions, recommendations, action plan design, follow-up and tracking. This may include use of the Plan, Do, Study, Act (PDSA) model for testing a change.
- Assists in preparation and review of reports for committees.
- Assists in preparing the organization for State audits.
- Maintains the confidentiality of records and reports for both KHS members.
- Performs in-depth medical records reviews as needed.
- Assists with internal QI investigations such as records reviews for member complaints involving potential quality of care issues.
- Work with the DHCS assigned Nurse Evaluator for KHS to plan ways by which we can improve provider’s compliance with State standards.
- May train RNs to be certified to conduct facility site reviews in accordance with DHCS requirements and conduct inter-rater reliability testing to validate a passing score prior to certifying them as site reviewers. Will inform DHCS of the plan’s new Site reviewers.
- Will perform facility site reviews as assigned.
- Review and educate QI team and other departments of All Plan Letters (APLs) released by DHCS and implement changes as necessary.
- Attend the DHCS Site Review Workgroup in person or by phone to keep abreast of updates on measures checked in site reviews, seek clarifications on changes to recommendations of different agencies such as AAP, Adult Preventive Task Force and implement changes as Recommended.
- Will attend trainings by DHCS, HSAG and NCQA related to QI activities such as performance improvement projects and audits for compliance with DHCS managed care accountability measures.
- May be required to review technical specifications for DHCS managed care accountability measures yearly and serve as content expert for select measures.
- Performs other job-related duties as required.
- Performs all job functions in a safe manner.
- 50% Travel required.
- Adheres to all company policies and procedures relative to employment and job responsibilities.
- Three (3) years of RN experience in direct patient care required; five (5) years preferred.
- Three (3) years of experience in QI in a managed care setting required.
- Experience with Medi-Cal managed health care preferred.
- Possession of a valid California Registered Nursing (RN) License
- Certified as either a State Certified Master Trainer for Facility Site Reviews OR is a Certified Professional in Healthcare Quality (CPHQ), AND
- Certified by DHCS as a Facility Site Reviewer.
Education: Possession of a valid California R.N. Bachelor of Science in Nursing (BSN) preferred. Completion of a nursing program from an accredited university, college, junior college, or school of nursing.
- Managed health care and Knox-Keene licensure requirements;
- Applicable State and NCQA standards and regulations pertaining to quality improvement management programs
- HEDIS data collection and analysis;
- Quality improvement study design methods and appropriate quality improvement tools and applications is preferred.
- Microsoft Office programs including Word, Excel, and PowerPoint.
- Communicate effectively with contracting physicians, other ancillary providers and internal departments.
- Address interpersonal issues that arise using conflict resolution skills.
- Problem-solve issues identified with projects, assignments, or processes.
- Write reports and clinical summaries in a clear, succinct, and professional manner.
- Maintain proper documentation and confidentiality.
- Possess good organizational skills and able to work independently.
Other: Possession of valid driver’s license and proof of State required auto liability insurance.
We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis.