The Quality Management Nurse Specialist RN II is responsible for overseeing the clinical aspects for quality improvement projects/activities, which may include but are not limited to the clinical review process for potential quality of care and service issues, regulatory compliance with CMS, DMHC, DHCS, and NCQA.

This position is 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 National Committee for Quality Assurance (NCQA) Accreditation.

Qualifications

Experience Required:

• At least 5 years of clinical experience as an RN in an acute hospital setting.

Preferred:

• Experience with regulatory compliance such as CMS, DMHC, DHCS, and NCQA.At least 5 years of managed care and/or quality improvement experience as an RN in a managed care/ healthcare setting preferably with Medicare ,Medi-Cal, or other government programs.
• Experience in the review of quality of care and service concerns, preferably complaints from member grievance.
• Experience in compliance, accreditation, service or quality improvement.Experience in facilitating workgroups and project management.

About the Hospital

As the nation's largest publicly-operated health plan, we have a great responsibility to the communities we serve, and our employees play an essential role in ensuring we meet those needs.

Why Join Us?
Opportunity. Amazing co-workers. A supportive management team. Great compensation and benefits. Camaraderie and a true sense of mission. If you want a career that truly contributes to the good of all, join us as we work towards a healthier L.A.