POSITION SUMMARY/RESPONSIBILITIES
Coordinates and collaborates with Community First Health Plans, Inc. (Community First), various departments to ensure that contractual, regulatory, and accreditation requirements, including National Committee for Quality Assurance (NCQA) and Healthcare Effectiveness Data and Information Set (HEDIS) are met as it pertains to the Quality Management Department. Monitors Community First performance on various quality metrics and benchmarks them against state and federal standards. Provides ongoing management of data collection systems and the development of procedures for monitoring, validating, and reconciling data for accuracy. May serve as a leader/facilitator of process improvement efforts. Provides oversight of and performs functions of review, investigation, and analysis of member-level clinical care data and provider performance as it compares to standards of care.
EDUCATION/EXPERIENCE
Graduation from an accredited school of professional nursing is required. Bachelor’s degree in nursing, clinical informatics, or other health care, or other health care related field is preferred. Five or more years of relevant healthcare experience is required. Experience in data analysis and preparation of quality improvement or related reports is preferred. Experience with Microsoft Office (Outlook, Word, Excel). Excellent communication and interpersonal skills are required. Quality Management certification such as CPHQ or CHCQM is preferred. Working knowledge of continuous process improvement principles and standard coding products is preferred.
LICENSURE
Current licensure as a Registered Nurse in the State of Texas is required.
