AlbuquerqueRecruiter Since 2001
the smart solution for Albuquerque jobs

Senior RN, Quality

Company: Optum
Location: Albuquerque
Posted on: October 16, 2020

Job Description:

Full-time Sr. RN Quality, Roma Location Overview of Position: The Quality Senior RN position is responsible for direction and guidance on clinical quality improvement and management programs including accreditation. Conducts clinical quality audits and may also be responsible for NCQA requirements. Responsible for the reporting and analysis of member care quality and for the development of plans and programs to support continuous quality improvement. Adheres to policies, procedures and regulations to ensure compliance and patient safety.-- Participation in Compliance and required training is a condition of employment.Essential Functions:

  • Review programs, policies and reports to ensure all elements are met.
  • Review /interpret / summarize records/data to address quality of care questions.
  • Review records for compliance with regulatory guidelines (e.g., NCQA, State, Clinical Practice Guidelines, CMS), verify necessary documentation is included in records.
  • Based on review of clinical data / documentation, identify potential quality of care issues (e.g., variations from standard practice potentially resulting in adverse outcomes) and potential fraud, waste and abuse. Refer issues identified to relevant parties for further review and actions.
  • Load completed information into relevant systems according to specifications.
  • Report results (e.g., quality improvement initiatives, audits) to committees, external stakeholders, regulatory agencies, etc. and respond to questions or solicit feedback and input.
  • Anticipates customer needs and proactively develops solutions to meet them.
  • Solves complex problems and develops innovative solutions.
  • Reviews work performed by others and provides recommendations for improvement.
  • Develop and discuss with sub-delegates and vendors corrective action plans
  • Educate vendors and sub-delegates on criteria and expectations
  • Explain/ convey specifications regarding action plans / develop or update work plans.
  • Develop, update, and/or review policies and procedures.
  • Review results, conduct analyses (e.g., evaluate against goals/effectiveness of interventions over time), and prepare reports on findings.
  • Educate, motivate, and/or influence others (e.g., leadership, other stakeholders), to understand the overall scope, overcome potential barriers, and engage in and commit to the process.
  • Communicate and explain applicable standards and/or technical specifications and identified gaps and/or changes in applicable standards
  • Work with others to ensure messaging to members and/or providers is appropriate to the audience, complete/accurate, and compliant.
  • Train others on relevant policies, rules, or regulations (e.g., appropriate release of data, handling protected health information)
  • Serve as a resource providing explanations and expertise.
  • Perform other duties as assigned.Education:Required- Associates Degree in NursingPreferred- Bachelor's degree or higher in healthcare related fieldExperience:Required - 5 years of clinical experience+ 1 year of clinical quality experience+ 1 year working in managed care or in the insurance industryRequired licensure: Required- Valid NM RN License or valid multi-state compact licensePreferred- Case Management Certification.Knowledge, Skills, Abilities:
    • Ability to evaluate medical records with attention to detail to perform quality audits
    • Experience with Medicare and/or Medicaid
    • Knowledge base of clinical standards of care, preventive health standards, HEDIS, NCQA, governing and regulatory agency requirements
    • Proficiency in software applications that include, but are not limited to, Microsoft Word, Microsoft Excel, Microsoft PowerPointAnticipates customer needs and proactively develops solutions to meet them.Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Here you'll find incredible ideas in one incredible company and a singular opportunity to do your life's best work.(SM)Diversity creates a healthier atmosphere: Optum and its affiliated medical practices are Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. Optum and its affiliated medical practices is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Keywords: Optum, Albuquerque , Senior RN, Quality, Healthcare , Albuquerque, New Mexico

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Healthcare Jobs


Case Management Travel Nurse RN - $2376 weekly
Description: Nomad Health, the modern healthcare staffing company, seeks an experienced registered nurse for this rewarding travel assignment opportunity.Join
Company: Nomad Health
Location: Albuquerque
Posted on: 10/28/2020

Travel Nurse RN - ICU - Intensive Care Unit - $2,782 per week
Description: American Mobile Healthcare is seeking a travel nurse RN ICU - Intensive Care Unit for a travel nursing job in Albuquerque, New Mexico.Job Description Requirements ul li Specialty: ICU - Intensive (more...)
Company: American Mobile Healthcare
Location: Albuquerque
Posted on: 10/28/2020

Travel Nurse RN - ED - Emergency Department - $1,594 per week
Description: trustaff is seeking a travel nurse RN ED - Emergency Department for a travel nursing job in Albuquerque, New Mexico.Job Description Requirements ul li Specialty: ED - Emergency Department li Discipline: (more...)
Company: NurseFly Travel Nursing
Location: Albuquerque
Posted on: 10/28/2020


Travel Nurse RN - PACU - Post Anesthetic Care - $1,584 per week
Description: MedPro Healthcare Staffing is seeking a travel nurse RN PACU - Post Anesthetic Care for a travel nursing job in Albuquerque, New Mexico.Job Description Requirements ul li Specialty: PACU - Post (more...)
Company: NurseFly Travel Nursing
Location: Albuquerque
Posted on: 10/28/2020

Travel Endoscopy RN
Description: Supplemental Health Care is partnering with a hospital in Albuquerque, NM to help fill an Endo RN opening they have open for travel. br br Unit: Endocrinology br br - 8 -hours Days shift br (more...)
Company: Supplemental Health Care
Location: Albuquerque
Posted on: 10/28/2020

Travel Speech Language Pathologist - $1,712 per week
Description: Club Staffing is seeking a travel Speech Language Pathologist for a travel job in Albuquerque, New Mexico.Job Description Requirements ul li Specialty: Speech Language Pathologist li Discipline: (more...)
Company: Club Staffing
Location: Albuquerque
Posted on: 10/28/2020

CVOR CST / ST, Cardiovascular
Description: Travel Surgical Technician Numerous Nationwide Travel Assignments / JobsCVOR General Surgery CST / STI spent 15 years in CVOR, Transplants Pedi, we all know CVOR Techs Rock, LolTired of completing (more...)
Company: Allied Health Travel Jobs
Location: Albuquerque
Posted on: 10/28/2020

Dialysis RN
Description: trustaff is currently seeking an experienced Dialysis Registered Nurse for a 13-week travel contract. br br Dialysis RNs provide care and support for patients suffering from acute and chronic renal (more...)
Company: trustaff
Location: Albuquerque
Posted on: 10/28/2020

Travel Nurse RN - ICU - Intensive Care Unit - $2,376 per week
Description: Anders Group is seeking a travel nurse RN ICU - Intensive Care Unit for a travel nursing job in Albuquerque, New Mexico.Job Description Requirements ul li Specialty: ICU - Intensive Care Unit li (more...)
Company: NurseFly Travel Nursing
Location: Albuquerque
Posted on: 10/28/2020

Orthopedic Surgery Physician Pediatric Surgeon - Physicians Only Apply - Perm
Description: Medical Doctors Only Apply. A Orthopedic Surgery Physician Pediatric Surgeon practice is seeking
Company: Adaptive Medical Partners
Location: Albuquerque
Posted on: 10/28/2020

Log In or Create An Account

Get the latest New Mexico jobs by following @recnetNM on Twitter!

Albuquerque RSS job feeds