Quality Improvement Nurse Specialist I at Capital District Physicians Health Plan Inc in Albany, New York

Job Description:

CDPHP and its family of companies are mission-driven organizations that support the health and well-being of our customers and the communities we are proud to serve. CDPHP was founded in Albany in 1984 as a physician-guided not-for-profit, and currently offers health plans in 29 counties in New York state. The company values integrity, diversity, and innovation, and its corporate culture supports those values wholeheartedly. At CDPHP, the employees have a voice and are encouraged to make an impact at both the company and community levels through engagement and volunteer opportunities. CDPHP invests in employees who share these values and invites you to be a part of that experience.

The Quality Improvement Nurse Specialist (QINS) contributes to the development and implementation of the Quality Enhancement program that meets CDPHP, federal, state and NCQA standards. The QINS will actively participate in all quality improvement team projects, and will utilize quality improvement methodologies and standard quality management tools. The QINS, in alignment with annual Corporate Goals/scorecard targets, will lead and/or participate in value added engagements with providers and identify areas where performance improvement is indicated through coordination of post project review (i.e. Plan-Do-Study-Act cycle).

QUALIFICATIONS:

• Associates degree required. Bachelor's degree preferred.


• Registered Nurse, NP, PA with valid New York State registration or license is required.


• Bachelor's degree in Science, Health Informatics Specialization, Health Management or Public Health/Epidemiology preferred.


• QINS - Level 1 - requires a Certified Professional Coder (CPC or CPC-A) credential within two years of hire date.


• Minimum one (1) year clinical experience is required.


• Minimum one (1) year quality management and experience with HEDIS measurements, annual reporting, medical record reviews and HEDIS auditing is preferred.


• Experience with CPT, HCPCS, ICD-10 codes required.


• Experience in Quality Improvement in the healthcare setting, including chart review and experience working with electronic records preferred.


• Experience with data retrieval, analysis, statistics and reporting preferred.


• Experience writing correction plans and performance improvement plans preferred.


• Experience with managed care products preferred.


• Experience with NCQA standards and the accreditation process preferred.


• Experience with group facilitation or project management is preferred.


• Experience with Microsoft Office, including Word, Excel, Outlook and PowerPoint is required.


• Demonstrated ability to conduct ongoing analysis of programs and implement enhancements to ensure quality performance and regulatory compliance.


• Demonstrated ability to manage several projects simultaneously and effectively while meeting established deadlines.


• Demonstrated ability to provide feedback in a constructive, positive format promoting results oriented actions.


• Demonstrated ability to pro-actively identify problems, as well as recommend and/or implement effective solutions.


• Demonstrated ability to provide excellent customer service and develop relationships both internally and externally.


• Demonstrated ability to work with and maintain confidential information.


• Excellent verbal and written communication skills.


• Flexibility to adapt to a changing and fast-paced environment.


• Access to reliable transportation. If driving vehicle for CDPHP business, employee must have valid driver's license, current inspection and appropriate insurance coverage in effect at all times is required. Ability to travel throughout CDPHP service area is required.

As an Equal Opportunity / Affirmative Action Employer, CDPHP does not discriminate in employment practices on the basis of race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship, disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, protected veterans status, or any other characteristics protected under applicable law. To that end, all qualified applicants will receive consideration for employment without regard to any such protected status.

CDPHP and its family of companies include subsidiaries Acuitas Health LLC, Strategic Solutions Management Consultants (SSMC), Practice Support Services (PSS), and ConnectRX Services, LLC.
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