Supervisor, Quality Improvement<
GENERAL
SUMMARY Oversees the quality improvement activities for Health Care
Plan.
ESSENTIAL RESPONSIBILITIES
- Assures
compliance with Coventry quality standards, National Committee for
Quality Assurance standards as well as URAC standards when appropriate.
- Assures
the maintenance of accurate documentation of all quality improvement
activities, i.e., surveys, audits, peer reviews, etc.
- Responsible
for preparing the agenda and managing the activities of the health plan's
Quality Improvement Committees, in conjunction with Medical Affairs.
- Remains
current with new developments in the field of quality improvement.
- Develops
new Quality Improvement activities in the health plan.
- Oversees
the annual Medical Record Documentation/Preventive Services clinical
study.
- Assures
that all quality improvement activities are conducted according to CQI
and URAC standards and that the appropriate data and documentation is
kept.
- Ensures
that quality improvement information, including the monitoring and
evaluation of indicators, is collected and reported to the Quality
Improvement Committee from the various health plan departments, including
credentialing, provider relations, health services, customer services.
- Maintains
data collection for HEDIS measures and identifies opportunities for
improvement based on the HEDIS results.
- Performs
other duties as required.
JOB
SPECIFICATIONS
- Registered
Nurse with a current RN license preferred.
- Bachelor?s
degree or equivalent experience preferred. Master?s degree preferred.
- Significant
experience (usually 3+ years) in quality improvement experience in a
managed care environment.
- Previous
(3-5 years) clinical experience or health education preferred.
- Excellent
organizational, supervisory and analytical skills required.
- Able to
work independently with minimal supervision.
- Able
to work effectively with multiple health plans, internal departments and
external vendors.
Billing
Address:
Coventry Health Care of LA
Tivis Nuzzolillo
HR Generalist
3838 No. Causeway Blvd., Suite 3350
Metairie, La. 70002
Phone: 504 834 0840 x 2127
Fax: 504 835 6498