Job Description

Responsibilities
• Participate in the coordination and development of goals and outcomes using HEDIS specifications for Quality Improvement and Corrective Action Plans
• Review generic charts, and other population-based data or abstractions, required by HEDIS, or the quality improvement process
• Track and trend reported quality related issues
• Serve as a clinical liaison between the Fund and Providers on quality-of-care concerns (HEDIS and other Performance Measures)
• Review performance, evaluate effectiveness, analyze data, identify trends, and collaborate with business leads to recommend quality enhancements
• Monitor gaps in care for a variety of mental health and medical chronic conditions for provider groups and individual providers and address them.
• Engage Fund Registered Nurses (RN), Health Educators (HE) and Social Workers (SW)in quality assurance projects, such as outreach to members with the gaps in care
• Provide supervision and clinical oversight of all the Wellness RNs and HEs activities
• Educate members regarding acute and chronic conditions and promote healthier lifestyle behaviors
• Participate in seasonal vaccination, and other types of testing, as needed
• Participate in Health Fairs, Screenings, and Outreach Events at New York City and outer borough locations, as needed
• Perform additional duties and projects as assigned by management

Qualifications
• Valid New York State Registered Nurse (RN) required; Bachelor’s degree in Nursing preferred
• Must have minimum of three (3) years of Quality Improvement experience, two (2) years of management experience and two (2) years nursing experience in ambulatory care, community health care or medical/surgical
• Must have strong experience in clinical assessment, patient education, motivational interviewing, critical thinking, independent decision-making, quality assurance and quality improvement processes
• Must have excellent nurse-physician communications skills.
• Knowledge of Healthcare Effectiveness Data and Information Set (HEDIS), and National Committee for Quality Assurance (NCQA)
• Intermediate computer and digital literacy
• Basic skills in Microsoft Outlook, Word and Excel preferred
• Bilingual in Spanish preferred
• Valid NYS Driver’s license preferred with travel in New York Metropolitan area
• Ability to work flexible hours including evenings and weekends as needed