Clinical Quality RN Honolulu, Hawaii at Honolulu

Job Description

Clinical Quality RNs conduct clinical quality audits and peer reviews, compile and maintain report data in a standard format to support accreditation and regulatory requirements. They are responsible for the reporting and analysis of member care quality and for the development of plans and programs to support continuous quality improvement. They assist in the application and interpretation of data to drive quality improvement efforts. Responsibilities:Completes standard quality reviews and audits, reports and analysis within agreed upon deadlines Routinely analyzes results of quality reviews to identify and report error trends Monitors clinical indicators and performance measures, conducts gap analyses and collaborates with others in the development and implementation of improvement efforts. Conducts Early and Periodic Screening, Diagnostic and Treatment outreach, education and tracking of children, teenagers and young adults under age 21 enrolled in the health planReviews issues/trends, develops interventions when needed, and reports relevant issues/trends to the site Quality Management (QM) CommitteeProvides internal and external training for organizations, providers, and other identified groups to improve understanding of quality and EPSDT programsManages assigned special projects to completion within target date Utilizes quality system tools/databases to capture relevant data Develops creative solutions to address identified quality problems Demonstrates leadership in continuous quality improvement Utilizes change management to drive resultsDevelops recommendations for quality remediation plans Shares best practices and supports team goals and objectives Drives consistency and efficient processes on the team Actively participates in quality improvement initiatives/meetings Responsible for maintaining and increasing self-proficiency in the use of quality tools and methods and the application of quality scienceCompetencies: Demonstrated clinical knowledge and expertise.Demonstrated problem solving abilityStrong critical thinking and analytical skillsDemonstrates knowledge of root cause identification and analysis Application of fundamental health care quality auditing concepts, practices, and proceduresSolid communication skills, both oral and writtenKnowledge of office computer applications, including Microsoft Office (Word, Excel and Powerpoint)Attention to detailEvolving leadership characteristics Demonstrated skills in organization, customer focus, networking, and collaboration Job Key Words: Hawaii, RN, Registered Nurse, Quality improvements, Quality, Honolulu, Quality of care, long term care, nursing facility, nursing home, audit review

Job Requirements

Hawaii RN LicenseUndergraduate degree in nursing (ADN or BSN) or equivalent experience required. 3+ years of clinical experience in a health care setting required; supervisory experience preferred.Quality audit review and analysis experience in a health care setting or managed care organization is preferred.Knowledge of health care products, delivery systems, claims processing and supporting systems.Knowledge of quality improvement methods and tools (eg. TQM, HEDIS, Six Sigma) preferred.Knowledge of sampling methods and measurement techniques preferred.Practical knowledge of Microsoft Word, Excel and PowerPoint applicationsUnitedHealthcare Community & State is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.If youre ready to help make health care work better for more people, you can make a historic impact on the future of health care at UnitedHealthcare Community & State.We contract with states and other government agencies to provide care for over two million individuals. Working with physicians and other care providers, we ensure that our members obtain the care they need with a coordinated approach.This enables us to break down barriers, which makes health care easier for our customers to manage. That takes a lot of time. It takes a lot of good ideas. Most of all - it takes an entire team of talent. Individuals with the tenacity and the dedication to make things work better for millions of people all over our country.You can be a part of this team. You can put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered.Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/VUnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.
Country: USA, State: Hawaii, City: Honolulu, Company: UnitedHealth Group.