Quality Improvement RN - 154255
Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs:
• Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women
• Children’s Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR
• Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions.
Improving Members' experiences is at the heart of every Community position. We strive every day to make sure that our Members have access to the high-quality health care they need and deserve.
Community is accredited by URAC for its health plan operations. We offer care management programs for asthma, diabetes, and high-risk pregnancy. An affiliate of the Harris Health System (Harris Health), Community is financially self-sufficient and receives no financial support from Harris Health or from Harris County taxpayers.
The Quality Improvement RN implements new and existing healthcare quality improvement initiatives and educational programs. Ensures maintenance of programs for members in accordance with prescribed quality standards. Reviews clinical data for clinical quality complaints; conducts data collection, reporting and monitoring for key performance measurement activities. Provides direction and implementation of URAC accreditation surveys and federal/state quality improvements/compliance activities.
- Associate Degree in Nursing and RN License required. License must be active and in good standing. Bachelor's Degree in Nursing preferred.
- Clinical Quality, Public Health or Healthcare, Certified Professional in Health Quality (CPHQ), Certified HEDIS Compliance Auditor (CHCA) preferred.
- Three years Managed Care experience required; with one year of Quality Improvement experience
- MS Word
- MS Access
- Demonstrated solid business writing experience
- Exceptional Verbal communicattion skills
- Operational knowledge and experience with Excel and Visio (flow chart equivalent).
Benefits and EEOC
Community employees’ benefits are provided by Harris Health. These benefits are designed to provide you with flexibility and choices in meeting your specific needs.
Community is an Equal Opportunity Employer.