Quality Improvement Coordinator II

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

📋 Description

• Conduct assessments of delegated entities to ensure adherence to quality standards, service performance, credentialing reviews, and medical record audits.

• Engage in community-related initiatives, including health fairs.

• Facilitate communication with agencies and healthcare providers.

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

• Address quality concerns and produce written summaries of findings.

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

• Record, investigate, and resolve both formal and informal complaints, as well as risk management and sentinel events concerning quality of care issues.

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

• Act as the primary liaison between community resources/agencies and the organization concerning clinical initiatives and technical support.

• Organize and lead meetings with delegated entities in line with their contractual obligations.

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

• Design and implement Corrective Action Plans.

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

• Identify best practices, explore new processes, and propose program enhancements.

• Coordinate QIC activities and conduct monthly meetings.

• Oversee compliance with contract terms regarding data submissions from delegated entities.

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

• Perform additional duties as assigned.

⛳️ Requirements

• A Bachelor’s degree in Nursing is preferred.

• A minimum of 3 years of clinical, quality improvement, or healthcare experience is required.

• At least 2 years of experience in a quality role within a healthcare environment is essential.

• Preferred licenses include LPN, LVN, RN, PA, or LCSW.

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

• Experience in abstractions and overreading is highly desirable.

• MedSurge experience is also highly preferred.

• Must comply with all organizational policies and standards.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase options.

• Tuition reimbursement programs.

• Paid time off in addition to holidays.

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

• Additional incentives may be included in the overall compensation package.