Quality Improvement Coordinator II

This is a fully remote position, open to applicants in Washington.

📋 Description

• Perform assessments of assigned entities to ensure adherence to quality standards, service performance, utilization, credentialing evaluations, and medical record audits.

• Engage in community outreach activities related to clinical initiatives, including health fairs.

• Liaise with agencies and healthcare providers.

• Conduct quality on-site evaluations of delegated entities and physician offices/clinics.

• Address quality concerns and create written summaries of findings.

• Follow up as instructed by the Medical Director and/or Credentialing and Quality Improvement Committee (QIC).

• Document, investigate, and resolve both formal and informal complaints, as well as manage risk and sentinel events associated with quality-of-care issues.

• Audit medical records, assess administrative claims, and analyze data for quality improvement studies and activities.

• Serve as the primary liaison between community resources/agencies and the company concerning clinical initiatives and technical guidance.

• Organize and lead meetings with delegated entities in alignment with their contracts.

• Collect data and compile reports on utilization and quality improvement.

• Develop and execute Corrective Action Plans.

• Suggest modifications and improvements to Quality Improvement policies and procedures.

• Identify best practices, research new methodologies, and propose program enhancements.

• Coordinate QIC activities and monthly meetings.

• Supervise adherence to contract stipulations regarding data submission from delegated entities.

• Contribute to the creation of reporting and data outcome reports.

• Undertake additional responsibilities as assigned.

• Adhere to all policies and standards.

⛳️ Requirements

• Bachelor's degree in Nursing is preferred.

• A minimum of 3 years of experience in clinical, quality improvement, or healthcare roles.

• At least 2 years of experience in a quality function within a healthcare environment.

• Licenses such as LPN, LVN, RN, PA, or LCSW are preferred.

• CPHQ (Certified Professional in Healthcare Quality) certification is preferred.

• RN license in Washington state is strongly preferred.

• Candidates residing in Washington state are strongly preferred.

• Ability to work during PST hours.

• Willingness to travel for intervention health events.

• Adhere to all policies and standards.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plans.

• Stock purchase plans available.

• Tuition reimbursement opportunities.

• Paid time off in addition to holidays.

• Flexible work arrangements, including remote, hybrid, field, or office schedules.

• Additional incentives may be included in total compensation.