IEHP

Quality Program Nurse, RN (Remote with field work)

IEHP  •  Remote  •  12 hours ago
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Job Description

What you can expect!

Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!

Under the direction of the Manager, Quality Management Nurses, Quality Program Nurses (QPN) are responsible for the implementation of Quality Management policies, procedures, and activities. QPN’s enforce DHCS regulatory requirements as pertaining to Facility Site Review (FSR) and Medical Record Review (MRR) criteria.

Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

Additional Benefits

Perks

IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more.

  • Competitive salary
  • State of the art fitness center on-site
  • Medical Insurance with Dental and Vision
  • Life, short-term, and long-term disability options
  • Career advancement opportunities and professional development
  • Wellness programs that promote a healthy work-life balance
  • Flexible Spending Account – Health Care/Childcare
  • CalPERS retirement
  • 457(b) option with a contribution match
  • Paid life insurance for employees
  • Pet care insurance

Key Responsibilities

  • Perform initial, periodic, and verification Site Review and Medical Record Surveys for assigned Primary Care Providers. Conduct other regulatory audits as assigned.
  • Review Primary Care Provider Corrective Action Plans (CAP) submissions and monitor CAP compliance.
  • Perform focused audits as directed by IEHP Subcommittees.
  • Perform annual HEDIS data abstractions.
  • Monitor assigned PCPs for potential problem hours and document findings.
  • Review QM reports and CAP log on a weekly basis. Responsible for Provider compliance and follow up.
  • Attendance and participation in Quality Management Committee and/or Subcommittee meetings, as needed.
  • Attend Site Review and Medical Record Survey training, as mandated by DHCS, to maintain and become a Certified Site Reviewer.
  • Attendance and participation in Quality Management, Medical Services, and other inter-departmental staff meetings as indicated.
  • Attendance and participation in Quality Management Committee or Subcommittee meetings, as directed.
  • Any other duties as required to ensure Plan operations are successful.

    • Qualifications

    Education & Requirements

    • Three (3) or more years of any individual or combined experience in Quality Assurance, Utilization Management, Case Management, provider liaison duties, and/or clinical experience in a hospital/clinical setting
    • Experience preferably in an HMO or Managed Care setting
    • Associate’s degree in Nursing from an accredited institution required
    • Bachelor’s degree in Nursing from an accredited institution preferred
    • Possession of valid Certified Site Reviewer Certificate issued from DHCS or participating Medi-Cal Managed Health Plan Provider
    • If not a CSR, the candidate should be willing and able to get certified within 6 months of hire
    • Possession of an Active, unrestricted, and unencumbered Registered Nurse (RN) license issued by the California BRN required
    • Valid State of California driver's license and valid automobile insurance

    Key Qualifications

    • Knowledgeable and understanding of nursing principles & evidence based practices
    • Computer applications: spreadsheet, database, and word processing.
    • Strong organizational, time-management, and critical thinking skills
    • Excellent written and verbal communication and interpersonal skills.
    • Highly skilled in interpersonal communication, including conflict resolution.
    • Minimal to moderate physical activity; may include standing, bending, sitting for long periods of time and repetitive motion
    • Ability to manage multiple projects with completing deadlines and changing priorities
    • Automobile travel within the Inland Empire
    • May periodically be required to report to IEHP’s main campus for in-person meetings or for other business needs as determined by IEHP leadership

    Start your journey towards a thriving future with IEHP and apply TODAY!

    Work Model Location

    Telecommute (All IEHP positions approved for telecommute work locations may periodically be required to report to IEHP’s main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership)

    Automobile travel within the Inland Empire

    May periodically be required to report to IEHP’s main campus for in-person meetings or for other business needs as determined by IEHP leadership

    Pay Range

    USD $91,249.60 - USD $120,910.40 /Yr.

    IEHP

    About IEHP

    With a mission to heal and inspire the human spirit, Inland Empire Health Plan (IEHP) is one of the top 10 largest Medicaid health plans, the largest not-for-profit Medicare-Medicaid public health plan in the country, and for the fourth year in a row, certified as A Great Place To Work®. Founded in 1996, IEHP supports more than 1.5 million Riverside and San Bernardino County residents enrolled in Medicaid or IEHP DualChoice (those with both Medi-Cal and Medicare). As of 2024, IEHP also offers Covered California plans, further ensuring health care access for even more IE residents. Today, IEHP has a robust network of quality doctors throughout our two counties and nearly 4,000 team members who are fully committed to the vision: We will not rest until our communities enjoy optimal care and vibrant health. To learn more, go to iehp.org.

    Comprehensive Benefits

    Competitive salary and a benefits package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and retirement plan.

    Mission: To heal and inspire the human spirit.

    Vision: We will not rest until our communities enjoy optimal care and vibrant health.

    Values: We do the right thing by: Placing our Members at the center of our universe; unleashing our creativity and courage to improve health and well-being; bringing focus and accountability to our work; and never wavering in our commitment to our Members, Providers, Partners, and each other.

    Winning Team Culture

    Certified as A Great Place To Work® four years in a row.

    Industry
    Healthcare & Social Services
    Company Size
    1,001-5,000 employees
    Headquarters
    Rancho Cucamonga, CA
    Year Founded
    1995
    Website
    iehp.org
    Social Media