· Responsible for conducting the functions of Quality Management in a timely, efficient manner and ensuring achievement of QM objectives.
· Specific responsibilities include, but are not limited to:
· creating and maintaining quality management files
· performing special studies or audits
· medical records reviews, supporting preparations for regulatory audits.
· Leads clinical quality improvement through focused activities on the HEDIS process and other clinical studies
· Evaluate the need for clinical intervention and, as appropriate, access, analyze, plan, implement and evaluate intervention options to assure success.
· Identify actions required to improve performance and work with regional and national teams to improve results.
· Define and document policies, procedures and processes.
· Experience with NCQA standards, quality management preferred.
· Strong project management, research and analytical skills.
· Current LVN licensed in TX.
· Three to five years of quality review and improvement experience preferred.
· Certifications & Licenses:
· Current LVN licensed in TX
Licensed Vocational Nurses