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RN, Quality Improvement, Camarillo, CA

Organization: Gold Coast Health Plan
Category: Nurse
Location: Camarillo, CA
Date Job Posted: August 29, 2022
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RN, Quality Improvement

Full Time Regular
Camarillo, CA, US

Requisition ID: 1375


The Quality Improvement (QI) Nurse will support the Quality Improvement Program, assisting the health plan to successfully achieve organizational objectives for quality and patient safety. This position will be responsible for core clinical functions within the Quality Improvement department, including quality reviews, reporting, and performance improvement activities. The Quality Improvement (QI) Nurse will work closely with the Director of Quality Improvement and the Chief Medical Officer to assess the Quality Improvement Program's outcomes, identify areas of needed improvement, and institute actions to promote the delivery of high quality care. This employee must be able to interpret the requirements of the Plan's regulatory bodies, and state and federal regulations, and institute processes/ programs to ensure compliance.


Reasonable Accommodations Statement

To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.

Essential Functions Statement(s)

  • Work closely with other departments of the Health Plan, the Ql staff, and Chief Medical Officer to achieve the goals of the QI department.
  • Lead the investigation, processing, and reporting of identified potential quality issues (PQIs) following the Plan's procedures and timelines.
  • Track and trend PQI outcomes for the purpose of QI reporting and prioritization of actions/interventions.
  • Annually review and edit relevant QI policies and procedures per APL updates, regulatory requirements, and/or required process changes.
  • Conduct facility site reviews (FSR) according to DHCS site survey requirements, and maintain the FSR database.
  • Ensure that clinical and service PQI standards and FSR processes are compliant with state and federal requirements.
  • Participate in the annual HEDIS project, including medical record abstraction and over-reads to determine compliance with HEDIS measures and optimize performance outcomes.
  • Participate in departmental quality improvement activities and audits, including but not limited to, medical record review, performance improvement projects (PIPs), PDSA processes, and CQI activities.
  • Lead, facilitate and/or participate in relevant committees and work groups; prepare reports, data or other materials for committee presentation.
  • Complete project-related communications, including job aides, member/physician communications, work plans/action plans, graphical analyses, and agendas/minutes, as applicable.
  • Research best practices, national and regional benchmarks, and industry standards in order to help promulgate quality outcomes for the Plan.
  • Demonstrate strong leadership skills and work ethic, with the ability to foster teamwork and work effectively with multi-disciplinary teams, multi-task, and adapt quickly to change.
  • Perform all other duties as assigned.


Competency Statement(s)

  • Leadership - Ability to influence others to perform their jobs effectively and to be responsible for making decisions.
  • Analytical Skills - Ability to use thinking and reasoning to solve a problem.
  • Research Skills - Ability to design and conduct a systematic, objective, and critical investigation.
  • Change Management - Ability to encourage others to seek opportunities for different and innovative approaches to addressing problems and opportunities.
  • Diversity Oriented - Ability to work effectively with people regardless of their age, gender, race, ethnicity, religion, or job type.
  • Goal Oriented - Ability to focus on a goal and obtain a pre-determined result.
  • Responsible - Ability to be held accountable or answerable for one’s conduct and full delivery on accountabilities.
  • Team Builder - Ability to convince a group of people to work toward a goal.


Education: Bachelor's Degree (four year college or technical school) Required, Field of Study: Nursing or related field

Experience: 3 plus years of clinical experience in Quality Improvement, Risk Management, Compliance, and/or Accreditation demonstrating increasing responsibility in clinical quality improvement.

Computer Skills: Personal computer skills with competency in the MS Office software including Word, Excel, PowerPoint, and Access.

Certifications & Licenses: Current and active California Registered Nurse (RN) License required. Valid California Driver's License required.

Other Requirements:

Knowledge of quality improvement processes and risk mitigation strategies in a managed care environment.

Knowledge of DHCS requirements, NCQA Accreditation standards, and HEDIS.

Analytical and problem solving acumen.

Excellent verbal and written communication skills and ability to interact in a positive manner within the medical/clinic community.

Team player who builds effective working relationships within and across teams.

Ability to work independently.

Strong organizational skills and ability to multi-task

Ability to analyze, interpret, apply and communicate policies, procedures and regulations.

Understanding and ability to perform data analysis, basic statistical skills including intermediate knowledge of Excel.

Proven experience with performance improvement methodologies required.

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