Quality Improvement Coordinator II - Clinical
About The Position
Coordinate and monitor quality improvement and organizational projects from inception to closure. Perform duties and functions to develop and implement quality improvement programs and initiatives at the corporate and individual health plan levels in accordance with NCQA, URAC, and state requirements. The candidate must live in Nevada. Work with the Director of Accreditation to assist with plan compliance with NCQA and URAC standards. Maintain Quality Improvement policies and procedures in compliance with those requirements and recommend changes or enhancements as indicated. Identify best practices, research new processes, and recommend program enhancements. Support project life cycles, including requirements gathering, creating project plans and schedules, managing resources, and facilitating execution, deployment, and closure. Assist with collecting and presenting data for identified quality improvement projects, including identifying data sources, methodology, and required timelines. Perform other duties as assigned and comply with all policies and standards.
Requirements
- Candidate must live in Nevada.
- At least 3 years of clinical experience.
- At least 1 year of experience in a quality function.
- RN, LPN, or LVN credential.
- Current state nursing license.
- Valid driver's license.
Nice To Haves
- Bachelor's degree in Nursing or a related medical field.
- Hands-on experience writing and implementing policies and procedures to support NCQA, URAC, or JCAHO accreditation standards.
- Basic understanding of the health insurance business, claims payment procedures, strategies, and trends in health care.
- Certified Professional in Healthcare Quality (CPHQ).
Responsibilities
- Coordinate and monitor quality improvement and organizational projects from inception to closure.
- Develop and implement quality improvement programs and initiatives at corporate and individual health plan levels in accordance with NCQA, URAC, and state requirements.
- Work with the Director of Accreditation to assist with plan compliance with NCQA and URAC standards.
- Maintain Quality Improvement policies and procedures in compliance with NCQA and URAC requirements and recommend changes or enhancements.
- Identify best practices, research new processes, and recommend overall program enhancements.
- Support project life cycles, including requirements gathering, creating project plans and schedules, managing resources, and facilitating project execution, deployment, and closure.
- Assist with collection and presentation of data for identified quality improvement projects, including identifying data sources, methodology, and data timelines.
- Perform other duties as assigned.
- Comply with all policies and standards.
Benefits
- Competitive pay
- Health insurance
- 401(k)
- Stock purchase plans
- Tuition reimbursement
- Paid time off
- Holidays
- Flexible approach to work with remote, hybrid, field, or office work schedules
- Additional forms of incentives may be included in total compensation
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
