What are the responsibilities and job description for the Healthcare Quality Management Specialist position at PSG Global Solutions Careers?
Apply now and our proprietary system will quickly have you in front of a live recruiter.
The Opportunity
Description
We're looking for a Quality Management Specialist NURSE , working in Insurance industry in Chicago, Illinois, United States .
- Perform on-site medical record reviews to evaluate delivery of care in relation to Enterprise clinical practice guidelines.
- Facilitate and monitor of assigned quality improvement projects.
- Consult with network physicians, Medical Group / IPAs, providers, members, and other resources, as appropriate, to assess, plan, facilitate implement, coordinate, monitor and evaluate options to meet clinical quality improvement project objectives and to promote high quality and cost-effective outcomes.
- Gather information, analyze, and communicate it, and develop recommendations regarding clinical quality improvement projects.
- Assist in addressing issues related to clinical quality improvement projects for the managed care programs to assure compliance with contractual arrangements, accreditation requirements, government regulations and employer group expectations.
- Assist in coordinating internal support functions for assigned clinical quality improvement projects.
- Analyze statistical reports to evaluate effectiveness of quality improvement projects as well as to identify opportunities for improvement.
- Cooperate with other members of the department and interfacing departments as a team to increase overall efficiencies in an effort to maintain or decrease administrative costs.
- Provide ongoing documentation of clinical quality improvement project interventions for quarterly and annual Quality Improvement Reports, and for accreditation reviews ensuring reporting accuracy and timeliness.
- Present clinical quality improvement project results to the Quality Improvement Workgroups and Managed Care QI Committees.
- Participate in physician and Medical Group / IPA trainings such as Managed Care Roundtables, Administrative Forums, and MG / IPA QI Fund Trainings.
- Function as preceptor for orientation of new employees.
- Coordinate and provide interface with medical groups and other practitioners regarding existing and proposed clinical quality improvement initiatives.
- Assist in meeting and interfacing with outside agencies and organizations such as Illinois Department of Public Health, American Academy of Pediatrics, American Diabetes Association, etc.
- Maintain and enhance knowledge of clinical nursing and regulatory standards by attending seminars, training sessions, etc.
- Attend internal / external meetings to keep apprised of quality improvement and managed care issues / information.
- Assist in day-to-day activities in an effort to achieve HCM annual divisional goals.
- Practice within the scope of licensure and / or certification and accreditation standards.
- Communicate and interact effectively and professionally with co-workers, management, customers, etc.
- Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.
- Maintain complete confidentiality of company business.
- Maintain communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested.
Our Client
Our client is a fast-growing industry-recognized staffing firm. Recruiting critical IT, Financial, Engineering, Healthcare, and Data Analytics talent. With 20 years' experience and growth.
Connections in Automotive, Healthcare, Retail, Financial & Insurance, and Professional & Business Services. Working to bring top talent together with premier organizations.
Big enough to have great opportunities. Small enough to care about finding the right one for you.
It'sabout relationships based on mutual interest. The results are low turnover, long-lasting partnerships and growth. Want to work for a company invested in your success?
Experience Required for Your Success
What Do You Think?
Does your experience reflect what it takes to be successful in this role? Do the work and challenges get you excited about what's possible?
