Position Title: Clinical Quality Improvement RN
Hours: M-F 8:00am – 5pm
Pay Rate: Starting at $60hr
Location: Field based Ventura County CA - Will be traveling to Providers and facilities
Requirements:
- Active California RN License
- 2+ years’ experience with Medi-Cal Regulations, DHCS and NCQA guidelines
- 2+ years Managed Care experience
- CSR Certificate (Certified site reviewer)
- Valid Driver’s License
Job Description:
- Lead timely investigation, resolution, documentation, and tracking of Potential Quality Issues (PQI) in accordance with Medi-Cal, DHCS, NCQA, and managed care quality standards.
- Conduct mandatory Facility Site Reviews (FSR) and Medical Record Reviews (MRR) to evaluate provider compliance, quality performance, regulatory adherence, and healthcare delivery standards.
- Monitor, analyze, and report on HEDIS measures, quality improvement initiatives, population health metrics, managed care quality scores, and provider performance indicators to identify opportunities for improvement.
- Develop, issue, and manage Corrective Action Plans (CAPs) for provider groups and healthcare organizations that fall below established quality, compliance, NCQA, DHCS, and regulatory benchmarks.
- Collaborate with providers, medical groups, and healthcare leadership to deliver provider education, quality improvement coaching, performance improvement plans, and regulatory re-education related to Medi-Cal, DHCS, NCQA, HEDIS, and managed care requirements.
- · Attend and actively participate in required DHCS trainings, quality workgroups, compliance meetings, accreditation activities, and provider education sessions to support continuous quality improvement and regulatory compliance.
- Partner with provider offices, clinics, and healthcare organizations to improve quality outcomes, patient care standards, healthcare effectiveness, risk adjustment awareness, and performance measurement initiatives
#INDCC
Pay: From $60.00 per hour
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Life insurance
- Mileage reimbursement
- Travel reimbursement
- Vision insurance
Education:
Experience:
- Medi-Cal Regulations, DHCS and NCQA guidelines : 2 years (Required)
- Managed Care: 2 years (Required)
License/Certification:
- RN License (Required)
- CSR Certificate (Certified site reviewer) (Required)
Work Location: On the road
