Quality Improvement, RN

Inland Empire Health Plan•Rancho Cucamonga, CA

8d•Hybrid

About The Position

Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience! Reporting to Director of Hospital Relations, the Quality Improvement, RN will facilitate quality improvement initiatives across the continuum of care (i.e. acute care hospitals, skilled nursing facilities, hospice agencies, etc.) to enhance the overall quality of care delivered to members. This position is responsible for identifying, developing, coordinating, promoting, supporting, and implementing assigned clinical quality, and/or service improvement projects and programs. The Quality Improvement, RN supports evidence-based practice integration, provider training/education, policy review/development, and regulatory/accreditation interpretation. The incumbent develops continuous and targeted activities to improve performance related to Centers for Medicare & Medicaid Services (CMS) Star Ratings, HEDIS, CAHPS, HOS, P4P and other identified performance measures. The Quality Improvement, RN provides direct support for multiple initiatives aimed at improving the quality and effectiveness of health care delivery and/or health care services. This position communicates with external partners, internal quality leaders, and stakeholders to ensure multi-disciplinary teams have the resources and information they need. Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

Requirements

Minimum four (4) years of clinical/health care experience, including at least two (2) years performing quality improvement analysis or project coordination functions required
Bachelor’s degree in science or health/healthcare related field from an accredited institution required
Certified Professional of Healthcare Quality (CPHQ), or other recognized quality improvement certificate required or obtained within one (1) year of hire (maintained through employment)
Possession of an active, unrestricted, and unencumbered Registered Nurse (RN) license issued by the California BRN required
Working knowledge of healthcare quality performance and measurement sets including CMS quality withhold, Managed Care Accountability Set, NCQA Quality Improvement Standards and HEDIS
Ability to apply knowledge of tools of continuous improvement, and work process redesign
Knowledge of advanced clinical processes and/or hospital operations
Requires knowledge of the local healthcare market, patient demographics and needs and plan-specific information
Good analytical and critical thinking skills
Proficient in all Microsoft Office applications, with an emphasis on Excel and PowerPoint
Effective communication skills (verbal, written and listening) with ability to interact with key stakeholders
Must exhibit attention to detail
Ability to successfully apply facilitation techniques to quality improvement project teams
Demonstrates problem solving, conflict management, and team collaboration to contribute to a productive work environment and achievement of goals
Ability to read and interpret data
Able to manage and prioritize assigned tasks and work efficiently under pressure to meet deadlines in a fast-paced environment
Ability to support the application of basic facilitation techniques within quality improvement project groups

Nice To Haves

Master’s degree in science or health/healthcare related field from an accredited institution preferred

Responsibilities

Participate in departmental and cross-functional teams; this includes supporting IEHP and external stakeholder workgroups that focus on quality improvement projects. Assist in tracking progress for improvement efforts related to Hospital value-based incentives (P4P, VBI, VBP, etc.), network-wide CMS star ratings, and specific performance metrics.
Coordinate activities to foster good working relationships with contracted hospitals, skilled nursing facilities, hospice agencies, providers, and other external partners to encourage their participation in quality improvement groups. Help organize forums for shared learning and best practice exchange to improve patient care outcomes.
Apply knowledge of clinical processes or hospital operations to support the development and implementation of specific activities (based on current results and best practices) intended to improve CMS Star Ratings, HEDIS, CAHPS, HOS, P4P, and other targeted performance measures.
Gather and compile information on evidence-based practices, national and regional benchmarks, and industry standards, and help integrate those findings into current improvement initiatives.
Track and monitor improvement activities by performing ongoing analysis of measured outcomes and reporting findings.
Compile and summarize performance outcomes data and draft initial feedback for review by senior staff before distribution to external partners regarding improvement progress.
Utilize performance improvement methodologies (i.e., Plan Do Study Act (PDSA)) to support the implementation and tracking of rapid-cycle improvement projects.
Participate in outreach initiatives, and document potential barriers, experienced challenges, and activities taken to resolve issues and improve outcomes.
Assist in the maintenance and organization of annual quality improvement program documents, compliance audits, policies and procedures, and related evaluations.
Support the development and delivery of materials for quality improvement training sessions and problem-solving tool workshops for QI teams and stakeholders. Lead intradepartmental quality improvement teams, programs, projects, and initiatives as assigned.
Continuously seek to enhance delivery and efficiency of external-facing quality improvement initiatives via technological advancement and internal-facing process improvement.
Translate data into meaningful information, draw conclusions, and relate findings to industry standards. Provide recommendations to departmental stakeholders and Quality Improvement Leadership Team regarding performance gaps, program implementation, and performance outcomes in order to maintain an effective Quality Improvement program.
Perform any other duties as required to ensure Health Plan operations and department business needs are successful.