Top 16 Rn quality assurance process improvement Jobs in Columbus

Sr Quality Improvement/HEDIS Spec, Health Plan Interventions (Remote In Ohio)
Molina Healthcare —Columbus, OH
- $54,922 - $107,099 a year
- Full-time
- Remote
- RN License
- Writing skills
- Analysis skills
- Health insurance
Denials RN Coordinator
Ensemble RCM LLC —Columbus, OH
- $62,500 - $79,800 a year
- Full-time
- Nursing
- RN License
- 5 years
- Tuition reimbursement
3d
Nurse RN
ComForCare Home Health Care - East Columbus —Reynoldsburg, OH
- $35 - $65 an hour
- PRN
- Nursing
- RN License
- Mid-level
- Mileage reimbursement
- Flexible schedule
Quick Apply
Registered Nurse
Rel's Place LLC —Columbus, OH
- $40.07 - $45.46 an hour
- Contract
- Hybrid work
- Background check
- CPR Certification
- Nursing
- Flexible schedule
Quick Apply
Nurse Account Manager - RN
Mullaney's Pharmacy —Columbus, OH
- $75,000 - $85,000 a year
- Full-time
- Nursing
- Skilled nursing facility
- RN License
- Health savings account
- AD&D insurance
Quick Apply
Homecare Operations Manager
PurposeCare —Columbus, OH
- $65,000 - $75,000 a year
- Office
- High school diploma or GED
- Bachelor's degree
- Paid holidays
- Health insurance
Quick Apply
Sterile Processing Technician-Mount Carmel St. Ann's
Mount Carmel —Westerville, OH
- Full-time
- Surgery
- Basic math
- High school diploma or GED
- Relocation assistance
- Health insurance
Procedural & Clinical Operations RN
360 Vascular Institute —Dublin, OH
- $45 - $55 an hour
- Part-time
- Background check
- Nursing
- RN License
- Free parking
- Health insurance
Quick Apply
7d
Emergency Medical Services Outreach Coordinator
OhioHealth —Columbus, OH
- Full-time
- Nursing
- RN License
- Mid-level
- Continuing education credits
Nurse Navigator, Maternal Fetal Medicine
OhioHealth —Columbus, OH
- Full-time
- Nursing
- RN License
- Mid-level
Director Nursing - Women's Newborn Services
OhioHealth —Columbus, OH
- Full-time
- Nursing
- RN License
- Hospital
Apheresis RN H11A
Nationwide Children's Hospital —Columbus, OH
- Part-time
- Nursing
- Patient monitoring
- RN License
EMS/Outreach Coordinator
OhioHealth —Columbus, OH
- $16 an hour
- Full-time
- Nursing
- RN License
- HIPAA
- Continuing education credits
Registered Nurse
Ohio Living —Delaware, OH
- Weekends as needed
- Nursing
- RN License
- English
Quick Apply
Registered Nurse RN - Hospice (PRN & Weekend On-Call)
Absolute Companies —Canal Winchester, OH
- PRN
- Nursing
- Clean driving record
- RN License
Quick Apply

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Sr Quality Improvement/HEDIS Spec, Health Plan Interventions (Remote In Ohio)
Molina Healthcare —Columbus, OH
If licensed, license must be active and unrestricted in state of practice. Implements evidence-based and data-informed key member intervention strategies…
$54,922 - $107,099 a year
Denials RN Coordinator
Ensemble RCM LLC —Columbus, OH
Extensive review of medical records for medical necessity criteria, filing written letters of appeal on denied claims, filing complaints with state Department…
$62,500 - $79,800 a year
3d

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rn quality assurance process improvement jobs near columbus

Sr Quality Improvement/HEDIS Spec, Health Plan Interventions (Remote In Ohio)

Molina Healthcare -
Columbus, OH

Apply Now

Job Details

Full-time
$54,922 - $107,099 a year

Benefits

Health insurance

Qualifications

Managed care
Managed care organization experience
Writing skills
Clinical program data analysis
Productivity software
Clinical data analysis

Full Job Description

Molina Healthcare of Ohio is hiring for a Sr Quality Improvement/HEDIS Specialist on our Health Plan Community Interventions team.
This role is remote however candidates must live in Ohio.

This role is laser focused on Quality Improvement using QI Science. This role will be assigned a primary population stream and will be expected to support improvement work for Medicare Stars Measures.

Highly qualified candidates will have the following experience-

Using the specific models for improvement required by the state of Ohio
Experience with a formal model like IHI or Lean or Six Sigma, Green or Yellow Belt Improvement
Power BI is helpful but expert level is not required
Familiarity with Medicare (Ideally the Duals population)
Familiarity with QI Science, Health Equity, Population Health, Health Management

This role also provides senior level support for clinical quality member intervention activities. Responsible for the developing and implementing new and existing member intervention initiatives including all lines of business (Medicare, Marketplace, Medicaid, etc.). Executes health plan member and community quality-focused interventions and programs in accordance with established program standards, and federal/state/National Committee for Quality Assurance (NCQA) regulations. Conducts data collection, monitors intervention activity including key performance measurement activities, reports intervention outcomes, and supports continuous improvement of intervention processes and outcomes.

Essential Job Duties

Implements evidence-based and data-informed key member intervention strategies including initiating and managing member and/or community interventions (e.g., removing barriers to care) and other federal and state quality initiatives.
Monitors and ensures that key member intervention activities are completed on time and accurately, and presents results to key departmental management and other applicable Molina departments.
Writes narrative reports to interpret regulatory specifications, explains programs and results of programs, and documents findings and limitations of department interventions.
Creates, manages, and/or compiles required documentation necessary to maintain critical program milestones, deadlines, and deliverables.
Participates in quality improvement (QI) activities, meetings, and discussions with and between other departments within the organization.
Supports provision of high-quality clinical care and services by facilitating/building strategic relationships with community-based organizations (CBOs).
Evaluates quality project/program activities and results to identify opportunities for improvement.
Raises gaps in processes that may require remediation to quality leadership.
Provides support for quality-related projects.
Provides training and support to new and existing quality member interventions team members.
Demonstrates flexibility when it comes to change management and maintains a positive outlook.
This position may require same day out of office travel 0 - 80% of the time, depending upon state-specific needs.
This position may require multi-day overnight travel on occasion, depending upon state-specific needs.

Required Qualifications

At least 3 years of experience in health care, and at least 2 years of experience in health plan quality member interventions in a managed care setting, or equivalent combination of relevant education and experience.
Demonstrated solid business writing experience.
Proficiency with data analysis, manipulation and interpretation.
Intermediate knowledge and understanding of HEDIS and NCQA.
Critical-thinking, problem-solving and analytical skills.
Attention to detail and organizational skills.
Ability to navigate change with flexibility and a positive outlook.
Ability to work independently in a fast-paced, deadline-driven environment.
Effective verbal and written communication skills.
Microsoft Office suite and applicable software programs proficiency, and ability to learn new information systems and software programs.

Preferred Qualifications

Experience with data reporting, analysis, and interpretation.
Experience with Medicaid, Medicare, and/or Marketplace government-sponsored programs.
Certified Professional in Health Quality (CPHQ).
Certified HEDIS Compliance Auditor (CHCA).

Registered Nurse (RN). If licensed, license must be active and unrestricted in state of practice.
*

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $54,922 - $107,099 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Apply Now

Refine Your Search

rn quality assurance process improvement jobs in columbus

Sr Quality Improvement/HEDIS Spec, Health Plan Interventions (Remote In Ohio)

Denials RN Coordinator

Nurse RN

Registered Nurse

Nurse Account Manager - RN

Homecare Operations Manager

Sterile Processing Technician-Mount Carmel St. Ann's

Procedural & Clinical Operations RN

Emergency Medical Services Outreach Coordinator

Nurse Navigator, Maternal Fetal Medicine

Director Nursing - Women's Newborn Services

Apheresis RN H11A

EMS/Outreach Coordinator

Registered Nurse

Registered Nurse RN - Hospice (PRN & Weekend On-Call)

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