Description
The Quality Management Nurse is responsible for conducting comprehensive facility site reviews (FSRs) to ensure compliance with healthcare standards and regulations. This role involves evaluation clinical practices, identifying areas for improvement, and implementing quality improvement initiatives to enhance patient care and safety. In this role, you will supports all Medical Group Health Education & Disease Management Programs utilizing established interventions, performing necessary surveys acting as the primary liaison between providers and office staff and Health Plans to facilitate appropriate Health Education opportunities. Additionally, you will performs HEDIS related activities, Pay for Performance activities, Provider Access and Availability Surveys (PAAS), investigates and resolves access-related patient issues, and develops QI reports and action plans, as necessary.
Key responsibilities include:
Occasional travel to various clinic sites and schedule and conduct medical record and facility site audits
Conduct thorough facility site reviews and medical record audits, including inspections of clinical areas, patient care practices, and administrative processes
Review medical records of services in preparation for health plan and/or regulatory audits for medical appropriateness by using established clinical protocols and health plan resource tools
Assess compliance with healthcare regulations, accreditation standards, and organizational policies
Extrapolate and prepare a detailed, organized analysis of the essential information gathered to address facility site reviews and medical record audits
Prepare detailed reports on findings from site reviews and present recommendations to management
Identify areas for improvement and develop action plans to address deficiencies. Develop corrective action plans as needed conducting appropriate follow up and provide related reports
Collaborate with healthcare providers and administrative staff to implement quality improvement initiatives
Provide education and training to internal staff on quality management practices and regulatory requirements
Assist in QM Department projects including but not limited to HEDIS/Pay for Performance, clinical studies and access surveys producing charts, graphs, and reports to demonstrate results and outcomes
Initiate and maintain QM activities required for the credentialing and re-credentialing process
Attend and participate in QM meetings preparing agendas, materials, minutes, and action follow-ups in a timely manner
Salary Range: $37.60 - $78.35 HourlyQualifications
Current LVN or RN licensure in the state of California required. If providing RN licensure, a BSN or MSN is required
Occasional travel to various UCLA clinics within the assigned geographic region with the option to connect remotely when necessary.
Three years or more of clinical nursing experience with at least 2 years in a quality management role
Strong knowledge of healthcare regulations, accreditation standards, and quality improvement methodologies
Excellent analytical, problem-solving, and communication skills
Occasional travel to various healthcare clinics/facilities within assigned geographic region
Ability to work independently and collaboratively in a team environment
Ability to operate a wide variety of office equipment, including computers, printers, copy machines, facsimile receiver/transmitter, scanners, and mailing equipment
Proficient computer skills including working knowledge of Microsoft Outlook, Word, Excel, PowerPoint
Ability to multi-task, work with frequent interruptions and meet deadlines
Must be detailed oriented, attentive, organized, and able to follow directions
Ability to communicate thoughts and information clearly and succinctly in writing as well as verbally
Ability to lift up to 25 pounds
UCLA Health welcomes all individuals, without regard to race, sex, sexual orientation, gender identity, religion, national origin or disabilities, and we proudly look to each person's unique achievements and experiences to further set us apart.
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