L.A. Care Health Plan Quality Management Nurse Specialist, RN in Los Angeles, California

DUTIES The Quality Management Nurse Specialist, RN is responsible for overseeing the clinical quality improvement projects and NCQQ related quality improvement activities. These projects may include, but are not limited to: managing the State-mandated Performance Improvement Projects (PIPS), oversight of the clinical practice guidelines, and managing wellness campaigns related to Asthma, Diabetes, and Immunizations. In this role, the Quality Management Nurse Specialist, RN responsible for ensuring program activities are completed in a high quality and timely manner and ensuring compliance with all regulatory guidelines such as Medicaid (Medi-Cal), Medicare, and the Health Exchange, as well as NCQA Accreditation. This position will report to the QI Initiatives Manager.


EDUCATION** Required Bachelor's Degree BSN

LICENSES/CERTIFICATIONS Required: Current and unrestricted CA RN License

EXPERIENCE Required: At least 3-5 years of managed care experience as an RN in a managed care/ healthcare setting preferably with Medicare or other government programs.

Must have excellent written and verbal communication and presentation skills. Ability to manage projects independently and assume responsibility for successful completion Ability to develop and maintain strong working relationships with internal and external clients/ customers /members. Must have excellent analytical skills, working knowledge of statistics and reporting. Must be detail-oriented and effective critical thinking skills. Experience in compliance, accreditation, service or quality improvement Experience in complex project management Proficient in Microsoft Office (Word, Excel) Strong interpersonal skills and high level of professionalism Ability to work independently and within a team environment

Preferred: Experience with Medicare and/or NCQA

Job Title: Quality Management Nurse Specialist, RN

Job Category: Clinical / Non-Clinical

Department: Quality Improvement

Location: Headquarters, Downtown Los Angeles

Position Type: Full-time

Position Control Number: 545A

Pay Grade: K