Registered Nurse at Health Insurance Company in San Francisco, California, United States —
- Health Insurance Company
- San Francisco, California, United States USA
- 5/24/20 2020-05-24
Job ID: 146505
We are seeking a Registered Nurse (RN) experienced in quality improvement, HEDIS, and insurance to fill a full-time permanent position with an esteemed healthcare organization located in the Greater San Francisco Bay area.
About the Opportunity:
This position will allow you to expand your knowledge and skill set working with a health plan that serves the greater good of the community it serves. Make a difference today!
Join a well-respected, collaborative, non-profit health care organization that specializes in providing member services to the community it serves. This organization provides services for all age populations within diverse, underserved areas but also has a focus on elderly and developmentally disabled populations.
This position is a day-time, Monday through Friday, 40 hours/week position
Registered Nurse (RN) will work as a Quality Improvement Nurse in a day-time, Monday through Friday, 40 hours/week position
Registered Nurse (RN) will conduct studies and analyze data to evaluate the performance of health plan in key clinical preventive and chronic care measures.
Registered Nurse (RN) will identify and implement interventions to improve performance and develop program goals and plans to meet the health plan’s internal quality goals as well as the needs of external regulatory and oversight entities.
Registered Nurse (RN) will perform computer-based statistical analysis of data related to the QI program and collect data from one or more sources including outpatient lab, claims and other data sources.
Registered Nurse (RN) will monitor and ensure the validity of data, utilize Plan data systems to generate, manipulate and analyze data, as well as evaluate reports for accuracy of data.
Registered Nurse (RN) will perform analysis to determine statistically significant trends in the data compared to industry standards and recognized benchmarks.
Registered Nurse (RN) will create process documentation for QI and/or HEDIS activities and collaborates with practices to integrate their electronic medical record data into systems.
Registered Nurse (RN) will collaborate with internal and external stakeholders to identify and act on opportunities for improvement in the area(s) of chronic and/or preventive care.
Registered Nurse (RN) will evaluate, monitor, and report compliance rates on a quarterly basis.
Analyze, develop and implement improvement activities to increase compliance rates as measured by nationally standardized benchmarks and definitions.
Perform oversight activities on entities with Plan delegated functions, regularly audit entities with Plan delegated function, develop, implement, and follow up with corrective action plans.
License and Certification: A valid California license as a Registered Nurse (unrestricted and in good standing)
Education and Experience: Bachelor’s degree in nursing or a related health services field is a plus. Two (2+) plus years of relevant nursing experience in a managed care/quality improvement type of setting.
Knowledge of: Thorough knowledge of the principles and methods of research methodology, statistical analysis and report design (preferred). Strong knowledge of HEDIS reporting. Strong knowledge of Medicare and Star ratings (strongly preferred). Strong understanding of relational databases. The concepts of managed health care. Title 22 regulations (preferred). Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, Access and PowerPoint.
Other: Must have own car, unrestricted driver’s license and insurance in conformity with California state
Benefits / Compensation:
$41/hour to $50/hour+ DOE
Strong benefits package including medical, dental, fully paid vision, life, AD&D, STD, and LTD insurance; retirement plan (10% of salary for compensation/HPSM paid); holiday and vacation pay; tuition reimbursement plan; and more.
Why Green Key? We care because you do.
A job in healthcare is about more than just the bottom line. We'll find you one that matters.