Quality Management Nurse Specialist RN II (ALD)
Los Angeles, 90017
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.
Leads and/or participates in multi-department/cross-functional committees and work groups which support key initiatives, prepares reports, data, agendas/minutes or other materials for committee presentation and management. Develops and implements project-related communication including, but not limited to, member/physician mailings, IVR scripts, emails, business plans, graphics, and maintains minutes and agendas.
- Associate's Degree in Nursing
- Education Preferred: Bachelor's Degree in Nursing
- 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. At least 3 years of clinical experience as an RN in an acute hospital setting Experience in the review of quality of care and service concerns, preferably complaints from member grievance.
- Licenses/Certifications RequiredRegistered Nurse (RN) - Active, current and unrestricted California License
- Licenses/Certifications Preferred
- Certified Professional in Healthcare Quality (CPHQ)
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.