Quality Improvement Manager (Must be Registered Nurse)

Collaborates with the Information Technology Department and with the Data Analyst to obtain relevant information to track and trend quality indicators.

Conducts internal audits of Healthcare Center and Case/Disease Management records/charts to identify areas for improved quality of care.

Conducts external audits of contracted network providers to maintain the quality and integrity of the network.

Establishes and utilizes benchmarks and thresholds as quality indicators.

Performs selected outcome studies.

Participates in developing a training program related to Quality Improvement.

Performs incident (complaint/grievance) investigations.

Develops corrective action plans in collaboration with management as needed.

Monitors and reports on NCQA or Joint Commission accreditation standards.

Participates on quality improvement teams.

Assists in the development of the annual QI Plan.

Conducts analysis of data collected to accomplish established QI Program goals.

Assists in the development and implementation of internal quality improvement projects as contractually mandated by the California Department of Health Services.

Assures ongoing, quarterly, semiannual and annual QI reports and evaluations are completed as prescribed in the overall QI plan.

Prepares quarterly QI reports for submission to the Board of Directors.

Participation in Meetings/Committees
• Attends QI meetings as assigned.
• Attends meetings as assigned.Education
Bachelor’s degree (B.A.) from four-year college or university; or one to two years related experience and/or training or equivalent combination of education and experience.

Computer/Software Skills & Abilities
To perform this job successfully, an individual should have knowledge of Database software; Internet software; Spreadsheet software and Word Processing software,

Other Skills & Abilities/Qualifications
• Five years experience in acute care, case management utilization review, or quality improvement management.
• Extensive knowledge of Microsoft Access, Excel and Word.
• Successful completion of a college level statistics class.
• BS/BA in health sciences, health management, or a related field preferred.

Certificates, Licenses and Registrations
• Licensed Registered Nurse with the California Board of Registered Nursing.