Quality Improvement Nurse Manager

Job Summary

The Quality Improvement Nurse Manager oversees, coordinates activities, and develops quality assurance and improvement programs to ensure member quality of care standards as outlined in the PASSE Provider Agreement and Empower protocols. The nurse manager also evaluates the effectiveness of quality assurance policies and procedures to enhance standards and quality of service.

Supervisory Responsibilities

• Develop and implement a positive and proactive Quality Improvement nursing team that implements quality plan initiatives and activities designed to drive improved health outcomes and close gaps in care.
• Lead the organization’s Quality Improvement Committee activities toward accomplishing the defined clinical Quality Assessment and Performance Improvement Plan (QAPI) goals.
• Effectively communicates with Senior Leadership reporting, administrative duties, and complete participation in leadership and team meetings.
• Assures staff training and continuing education regarding processes, programs, standards, and guidelines, including NCQA and HEDIS.
• Support team members with achieving career goals.
• Hires, trains, coaches, counsels, and evaluates the performance of direct reports.
• Must actively contribute to the Empower Integrated Care team.
• Must drive Chronic Condition Management, Transitional Care, and other nurse/clinical programs.
• Develop materials and programs that improve the physical and behavioral health of the membership in collaboration with Care Coordination.
  
  

Duties/Responsibilities

• Manages day-to-day medical quality assurance and improvement programs
• Refine and develop quality assurance initiatives and programs as needed.
• Works with internal and external customers to promote understanding of health services activities and objectives with Empower and to prioritize departmental projects.
• Maintains expert knowledge of current NCQA standards, quality improvement activities, and solid medical management skills.
• Working with the medical director guides the clinical/nurse team in making medical decisions.
• Provide the Medical Director department status reports as defined by the Medical Director.
• Responsible for the team members’ satisfaction scores.
• Interfaces with state entities regarding Incident Reporting/Potential Quality of Care Concerns as needed.
• Drives the development of Medical programs relevant to the member population in collaboration with Care Coordination management.
• An education program regarding physical and medical care for the care coordinators and members.
• Follows HIPAA requirements that meet the security and confidentiality of records and information.
• Remains current with up-to-date, appropriate medication, medical-surgical, behavioral health, home, and transitional care practices to identify general trends in health care delivery.
• May be required to participate in care coordination at home and inpatient settings to assist with the management of care.
• Other duties as assigned
  
  

Required Skills/Abilities

• Must have excellent leadership skills and the ability to develop and maintain superior relations with physicians and staff at all levels.
• Must have excellent written, computer, and oral communication skills.
• Knowledgeable of NCQA/HEDIS requirements and standards.
• Must be knowledgeable of the state process for incident reporting, critical incidents, and potential quality of care concerns, as well as the necessary cases the state needs to follow up with.
• Must become familiar with the Milliman Care Guidelines (MCG) and drive the medical programs with standards of care and clinical practice guidelines.
• Practices nursing within the scope of licensure and adheres to Empower policies and procedures, federal and state regulations, accreditation entity and state contract requirements.
• Knowledge of provider billing and coding
• Demonstrates initiative, flexibility, integrity, and diplomacy.
• Ability to work within deadlines.
  
  

Education And Experience

• Registered nurse license, active and unencumbered Arkansas state license
• A bachelor’s degree in a clinical or healthcare field is preferred; equivalent experience may substitute for education.
• Five (5) years of management experience in a healthcare environment can supplement the bachelor’s degree if the candidate is an associate degree nurse.
  
  

Physical Requirements

• Prolonged periods of sitting at a desk and working on a computer.
• Must be able to lift up to 15 pounds at times.
• Must be able to practice the Empower highbred work schedule.