GENERAL SUMMARY
Responsible for the research and identification of quality of care issues to ensure compliance with Coventry’s quality improvement programs as well as accreditation and regulatory standards.
ESSENTIAL RESPONSIBILITIES
- Performs quality improvement studies as they relate to trends identified via utilization review activities, utilization patterns, audits, Healthcare Effectiveness Data and Information Set (HEDIS) results, appeals, etc.
- Maintains accurate documentation of all quality improvement activities, i.e., studies, surveys, audits, peer reviews, etc. Performs analysis and provides oversight for delegated functions.
- Identifies possible quality of care issues through research and data analysis. Prepares and distributes accurate and timely reports according to department policies, documentation standards, and regulatory requirements.
- Under the direction of assigned Medical Directors and quality improvement management, conducts audits to research quality of care issues.
- Assists in conducting peer review chart audits, compiling statistics, and reporting results to the appropriate oversight committees.
- Monitors and assures that follow-up re-evaluation activities take place when deficiencies are identified and recommendations for corrective action have been made.
- Develops and provides training to members and employer groups regarding preventive health and wellness as they relate to trends identified via review activities and audits.
- Assists in preparing the annual quality improvement program evaluation and work plan.
- May complete an annual review of department policies and procedures and make recommendations for updates based on changing needs or trends.
- Performs other duties as required.
Qualifications:
JOB SPECIFICATIONS
- Licensed Practical Nurse (LPN) or Registered Nurse (RN) with active state license required.
- Complies with all state certification requirements in the state where job duties are performed.
- Previous (2-4 years) clinical experience required.
- Previous quality improvement and/or managed health care experience preferred.
- Fundamental knowledge of relevant legal, medical, and regulatory terms, issues, and practices.
- Excellent verbal and written communication skills.
- Demonstrated data analysis and report preparation skills.
- Knowledge of standard software packages required, including Word, Excel, and Powerpoint.
- Valid driver’s license may be required.
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
Job: Professionals
Primary Location: Metairie, LA, US
Organization: 14000 - CHC of Louisiana
Schedule: Full-time
Job Posting: 2013-02-08 00:00:00.0
Job ID: 1310515