Quality Management Nurse Consultant

WFH
- Monday through Friday 8a-5p in time zone of residence

Applies specialized clinical and industry knowledge and performance improvement best practices to quality improvement efforts. Analyzes workflow and organizational performance to evaluate effectiveness of interventions and ensure continuous alignment with regulatory and accreditation standards. Supports and drives the implementation, measurement, and evaluation of POSC Council workplans. Supports POSC Council and executive sponsors to advance initiatives aimed to achieve HEDIS and CAHPS goals.

Provides insights and recommendations to optimize healthcare practices and achieve highest standards of care and service delivery, in alignment with industry and accreditation best practices.

• Develops and implements quality improvement programs and initiatives to monitor and improve healthcare services and processes. Quantitatively and qualitatively analyzes organizational systems and performance in alignment with regulatory and accreditation standards.
• Drives and implements evidence-based performance improvement interventions that address areas for improvement, reduce variations in care, and enhance clinical effectiveness. Establishes, tracks and monitors process and outcome measures. Prepares materials and organizational documents and effectiveness for POSC Forum, POSC Council and POSC workgroup discussions in alignment with relevant project plans.
• Manages and coordinates specific workplans for assigned POSC work groups. Facilitates relevant work groups and committees as required to ensure stakeholder awareness and participation.
• Contributes to enhancing healthcare services, improving patient outcomes, and ensuring adherence to regulatory requirements and industry standards.
• Contributes to the development, revision, and implementation of policies, procedures, and guidelines that focus on system performance, network provider and community partner performance, and addressing barriers including health disparity and health related social needs, to improve clinical quality, promote best member and provider experience, and ensure patient safety.
• Stays up to date on healthcare innovations, quality studies and evidence-based practices by participating in research efforts, contributing to scholarly publications, and/or facilitating research utilization to improve clinical care and outcomes.
• Provides training and education to healthcare professionals, staff, and stakeholders on HEDIS and CAHPS related performance, workflow, and dependencies.
• Collaborates with all POSC stakeholders and participants to ensure cross-functional collaboration, education and participation in establishing, measuring and evaluating best practice interventions aimed to achieve Quality performance goals.

• 5-7 years prior relevant work experience – in clinical, case management, administrative, quality /compliance or HEDIS performance-based roles
• In depth knowledge of managed care quality, HEDIS and STARs measures, as well as initiatives aimed to drive performance
• Strong interpersonal, critical thinking, and analytic skills
• Working knowledge of quantitative / qualitative data analytics, and critical thinking skills.
• Working knowledge of clinical and practice requirements essential to meet patient care needs.
• Ability to deal tactfully with customers and community.
• Ability to manage sensitive information ethically and responsibly.
• Ability to consider the relative costs and benefits of potential actions to choose the most appropriate option.
• Ability to function in clinical setting with diverse cultural dynamics of clinical staff and patients.
• Excellent communication/presentation and technical writing skills
• Regis…