The role is responsible for coordinating the Quality Management Program through problem identification and investigation of quality-related member and practitioner inquiries
Job Summary
The role is responsible for coordinating the Quality Management Program through problem identification and investigation of quality-related member and practitioner inquiries.
Candidates must ensure plan compliance with state and federal regulations while supporting NCQA accreditation and performing facility site visits.
The position requires developing educational publications and tools to improve physician and member behavior regarding clinical practice guidelines.
Matching Summary
The role is responsible for coordinating the Quality Management Program through problem identification and investigation of quality-related member and practitioner inquiries.
Skills & Requirements
Must-have
Coordination of quality management programs
Investigation of quality-related inquiries
Analysis of QI activity results
Development of corrective action plans
Conducting medical record reviews and audits
Nice-to-have
Excellent organizational skills for multiple projects
Ability to identify complex medical service problems
Self-directed project initiation and completion
Collaboration with internal committees and stakeholders
Key Requirements
Bachelor's degree in Nursing or health-related discipline
Current unrestricted Michigan RN license
Five years broad clinical experience
One year Quality Management experience
Basic knowledge of Microsoft Excel and Access preferred