What are the responsibilities and job description for the Supervisor, HEDIS Nursing position at SCAN?
Remote
About SCAN
SCAN Group is a not-for-profit organization dedicated to tackling the most pressing issues facing older adults in the United States. SCAN Group is the sole corporate member of SCAN Health Plan, one of the nation’s leading not-for-profit Medicare Advantage plans, serving more than 270,000 members in California, Arizona, and Nevada. SCAN has been a mission-driven organization dedicated to keeping seniors healthy and independent for more than 40 years and is known throughout the healthcare industry and nationally as a leading expert in senior healthcare. SCAN employees are a group of talented, passionate professionals who are committed to supporting older adults on their aging journey, while also innovating healthcare for seniors everywhere. Employees are provided with in-depth training and access to state-of-the-art tools necessary to do their jobs, as well as development and growth opportunities. SCAN takes great pride in recognizing our team members as experts in their fields and rewarding them for their efforts. If you are interested in becoming part of an organization that is innovating senior healthcare visit www.thescangroup.org, www.scanhealthplan.com, or follow us on LinkedIn, Facebook, and Twitter.
The job
Supervise both regular and seasonal Quality Initiatives Nurse Reviewers. Function as the HEDIS® subject matter expert and oversee the implementation of Quality Initiatives and organizational objectives.
You will
Oversee the work of the Quality Initiatives Nurse Reviewers and Lead Nurse Reviewers to ensure target productivity levels are met and that the medical record abstraction process adheres to quality guidelines.
Recommends and implements corrective action programs when internal or vendor performance does not meet expectations.
Resolves escalated audit issues related to the medical record object.
Develops training materials and conducts training for internal clinical staff, related to HEDIS® and QI projects (care gaps). Oversees progress towards established goals and reprioritizes work as needed.
Accomplishes staff results by communicating job expectations; planning, monitoring, and appraising job results; coaching and counseling employees; initiating, coordinating, and enforcing systems, policies, and procedures.
Maintains staff by recruiting, selecting, orienting, and training employees; maintaining a safe and secure work environment; developing personal growth opportunities.
Maintains professional and technical knowledge by conducting research and by attending educational and technological workshops. This position requires contributions to team effort by accomplishing and sharing related results with other staff.
Contributes to team effort by accomplishing related results and assisting with outreach projects as needed.
Assist family and patients with escalated issues. Tracks quality control, budgeting activities, compliance, and overall financial performance of the unit. Mentors and provide career development to nursing staff. Liaisons with staffing coordinators on matters of shift schedules and potential opening for nursing positions.
Ensure proper nursing care is delivered to patients. Administers policies for documenting patient's conditions, vital statistics, diagnosis, and prescribed treatments. Provides guidance to nurses who provide treatment and administer medications.
All other duties as assigned.
Your Qualifications
Bachelor’s Degree preferred
A comparable combination of education/experience and/or training will be considered equivalent to the education listed above
RN, LVN, or RHIT required. Of the three, RN is preferred.
Supervises/Manages Others (i.e. hires, performance reviews, corrective action, etc.)
3 years clinical experience, or other relevant experience preferred.
2 years of quality improvement experience, or other relevant experience preferred.
Knowledge base of clinical standards of care, preventative health standards, HEDIS®, NCQA, regulatory agency requirements, and the managed care industry.
PC Skills: Word, Excel, Visio, PowerPoint, Outlook
Leadership - Basic Skills To Develop Others
Problem Solving - Basic problem-solving skills
Communication - Good communication and interpersonal skills
Supervisory skills: Ability to oversee, mentor, and manage Nurse Reviewers and Lead Nurse Reviewers to ensure they meet productivity targets and quality standards.
Coaching and performance management: Skilled at providing feedback, conducting appraisals, and offering corrective actions when necessary. Medical record abstraction: Expertise in ensuring accurate and efficient medical record abstraction, adhering to clinical and quality guidelines.
Audit resolution: Strong ability to handle and resolve escalated issues related to medical record audits and quality improvement projects. Initiative management: Capable of recommending and implementing quality improvement programs to drive performance enhancements in clinical settings.
Issue resolution: Strong problem-solving abilities to address escalated audit issues and to resolve performance gaps.
Adaptability: Ability to quickly respond to challenges, reprioritize tasks, and adjust strategies as needed to meet goals. Experience in leading teams through process changes and improvements.
Clear communication: Strong communication skills to convey job expectations, provide feedback, and report on progress.
Team collaboration: Works well in teams, contributing to collective goals and assisting with outreach projects when needed. Ability to work across departments (e.g., nursing, physicians, administration) to ensure cohesive quality initiatives.
What’s in it for you?
Base Salary range: $92,400.00 - $147,800.00
An annual employee bonus program
Robust Wellness Program
Generous paid-time-off (PTO)
Eleven paid holidays per year, plus 1 additional floating holiday
Excellent 401(k) Retirement Saving Plan with employer match.
Robust employee recognition program
Tuition reimbursement
A work-life balance
An opportunity to become part of a team that makes a difference to our members and our community every day!
We're always looking for talented people to join our team! Qualified applicants are encouraged to apply now!
At SCAN we believe that it is our business to improve the state of our world. Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource groups, inclusive benefits, and more.
SCAN is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.
About SCAN
SCAN Group is a not-for-profit organization dedicated to tackling the most pressing issues facing older adults in the United States. SCAN Group is the sole corporate member of SCAN Health Plan, one of the nation’s leading not-for-profit Medicare Advantage plans, serving more than 270,000 members in California, Arizona, and Nevada. SCAN has been a mission-driven organization dedicated to keeping seniors healthy and independent for more than 40 years and is known throughout the healthcare industry and nationally as a leading expert in senior healthcare. SCAN employees are a group of talented, passionate professionals who are committed to supporting older adults on their aging journey, while also innovating healthcare for seniors everywhere. Employees are provided with in-depth training and access to state-of-the-art tools necessary to do their jobs, as well as development and growth opportunities. SCAN takes great pride in recognizing our team members as experts in their fields and rewarding them for their efforts. If you are interested in becoming part of an organization that is innovating senior healthcare visit www.thescangroup.org, www.scanhealthplan.com, or follow us on LinkedIn, Facebook, and Twitter.
The job
Supervise both regular and seasonal Quality Initiatives Nurse Reviewers. Function as the HEDIS® subject matter expert and oversee the implementation of Quality Initiatives and organizational objectives.
You will
Oversee the work of the Quality Initiatives Nurse Reviewers and Lead Nurse Reviewers to ensure target productivity levels are met and that the medical record abstraction process adheres to quality guidelines.
Recommends and implements corrective action programs when internal or vendor performance does not meet expectations.
Resolves escalated audit issues related to the medical record object.
Develops training materials and conducts training for internal clinical staff, related to HEDIS® and QI projects (care gaps). Oversees progress towards established goals and reprioritizes work as needed.
Accomplishes staff results by communicating job expectations; planning, monitoring, and appraising job results; coaching and counseling employees; initiating, coordinating, and enforcing systems, policies, and procedures.
Maintains staff by recruiting, selecting, orienting, and training employees; maintaining a safe and secure work environment; developing personal growth opportunities.
Maintains professional and technical knowledge by conducting research and by attending educational and technological workshops. This position requires contributions to team effort by accomplishing and sharing related results with other staff.
Contributes to team effort by accomplishing related results and assisting with outreach projects as needed.
Assist family and patients with escalated issues. Tracks quality control, budgeting activities, compliance, and overall financial performance of the unit. Mentors and provide career development to nursing staff. Liaisons with staffing coordinators on matters of shift schedules and potential opening for nursing positions.
Ensure proper nursing care is delivered to patients. Administers policies for documenting patient's conditions, vital statistics, diagnosis, and prescribed treatments. Provides guidance to nurses who provide treatment and administer medications.
All other duties as assigned.
Your Qualifications
Bachelor’s Degree preferred
A comparable combination of education/experience and/or training will be considered equivalent to the education listed above
RN, LVN, or RHIT required. Of the three, RN is preferred.
Supervises/Manages Others (i.e. hires, performance reviews, corrective action, etc.)
3 years clinical experience, or other relevant experience preferred.
2 years of quality improvement experience, or other relevant experience preferred.
Knowledge base of clinical standards of care, preventative health standards, HEDIS®, NCQA, regulatory agency requirements, and the managed care industry.
PC Skills: Word, Excel, Visio, PowerPoint, Outlook
Leadership - Basic Skills To Develop Others
Problem Solving - Basic problem-solving skills
Communication - Good communication and interpersonal skills
Supervisory skills: Ability to oversee, mentor, and manage Nurse Reviewers and Lead Nurse Reviewers to ensure they meet productivity targets and quality standards.
Coaching and performance management: Skilled at providing feedback, conducting appraisals, and offering corrective actions when necessary. Medical record abstraction: Expertise in ensuring accurate and efficient medical record abstraction, adhering to clinical and quality guidelines.
Audit resolution: Strong ability to handle and resolve escalated issues related to medical record audits and quality improvement projects. Initiative management: Capable of recommending and implementing quality improvement programs to drive performance enhancements in clinical settings.
Issue resolution: Strong problem-solving abilities to address escalated audit issues and to resolve performance gaps.
Adaptability: Ability to quickly respond to challenges, reprioritize tasks, and adjust strategies as needed to meet goals. Experience in leading teams through process changes and improvements.
Clear communication: Strong communication skills to convey job expectations, provide feedback, and report on progress.
Team collaboration: Works well in teams, contributing to collective goals and assisting with outreach projects when needed. Ability to work across departments (e.g., nursing, physicians, administration) to ensure cohesive quality initiatives.
What’s in it for you?
Base Salary range: $92,400.00 - $147,800.00
An annual employee bonus program
Robust Wellness Program
Generous paid-time-off (PTO)
Eleven paid holidays per year, plus 1 additional floating holiday
Excellent 401(k) Retirement Saving Plan with employer match.
Robust employee recognition program
Tuition reimbursement
A work-life balance
An opportunity to become part of a team that makes a difference to our members and our community every day!
We're always looking for talented people to join our team! Qualified applicants are encouraged to apply now!
At SCAN we believe that it is our business to improve the state of our world. Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource groups, inclusive benefits, and more.
SCAN is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.
Salary : $92,400 - $147,800
