Clinical Nurse Analyst - Quality Improvement - Hybrid Remote
Clinical Nurse Analyst - Quality Improvement - Hybrid Remote
Fallon Health
Worcester, MA
See who Fallon Health has hired for this role
Overview
About us:
Fallon Health is a company that cares. We prioritize our members—always—making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high-quality, coordinated care and is continually rated among the nation’s top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge, self-expression, and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio-economic status, and other characteristics that make people unique. Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs—including Medicare, Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)— in the region. Learn more at fallonhealth.org or follow us on Facebook, Twitter and LinkedIn.
Brief Summary Of Purpose
Under the general direction of the Senior Manager, Clinical Quality, the clinical nurse analyst is responsible for developing and implementing the assigned quality improvement initiatives, documentation of the processes, tracking of results and reporting outcomes. Other key responsibilities include medical record data abstraction for Healthcare Effectiveness Data and Information Set (HEDIS®) and MassHealth Appendix Q review. The clinical nurse analyst will provide clinical expertise and support for departmental initiatives and the Quality Program structure as well as periodically assist in file review for NCQA accreditation.
Responsibilities
Primary Job Responsibilities:
Education:
Bachelor’s Degree in nursing preferred.
License/Certifications
#P02
About us:
Fallon Health is a company that cares. We prioritize our members—always—making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high-quality, coordinated care and is continually rated among the nation’s top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge, self-expression, and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio-economic status, and other characteristics that make people unique. Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs—including Medicare, Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)— in the region. Learn more at fallonhealth.org or follow us on Facebook, Twitter and LinkedIn.
Brief Summary Of Purpose
Under the general direction of the Senior Manager, Clinical Quality, the clinical nurse analyst is responsible for developing and implementing the assigned quality improvement initiatives, documentation of the processes, tracking of results and reporting outcomes. Other key responsibilities include medical record data abstraction for Healthcare Effectiveness Data and Information Set (HEDIS®) and MassHealth Appendix Q review. The clinical nurse analyst will provide clinical expertise and support for departmental initiatives and the Quality Program structure as well as periodically assist in file review for NCQA accreditation.
Responsibilities
Primary Job Responsibilities:
- Develop and implement assigned improvement strategies that support Fallon’s strategic goals.
- Implement, monitor, analyze and report quality improvement activities to ensure that Fallon members receive quality care in compliance with regulatory and contractual requirements.
- Reviews and abstracts clinical data from paper and electronic medical records for various needs and projects within the department, maintaining an inter-rater reliability score of 96% or above at all times.
- Particpates in the development of the annual Quality Work Plan and Work Plan Evaluation.
- Assist in the annual development of performance improvement initiatives as required.
- Maintains case review database and provides quarterly reporting.
- Participates in special projects as assigned, such as the NCQA Health Plan Accreditation, MassHealth Performance Improvement Plans (PIP), Compliance audits etc.
- Ensures the privacy and security of PHI (Protected Health Information) as outlined in Fallon policies and procedures related to HIPAA compliance.
- Participates in internal and external QI audits.
- Develop, update, and/or review policies and process documents
- Read and interpret standards/requirements and/or technical specifications
- Develop educational materials for members and/or providers
Education:
Bachelor’s Degree in nursing preferred.
License/Certifications
- RN with a current Massachusetts nursing license.
- CPHQ certification preferred
- Minimum of 3-5 years’ experience in Managed Care setting.
- Quality management/performance improvement, Lean-Six Sigma certification preferred.
- Strong clinical, interpersonal, analytical and communication skills.
- Knowledge in medical record review with proven results.
#P02
-
Seniority level
Mid-Senior level -
Employment type
Contract -
Job function
Health Care Provider -
Industries
Insurance
Referrals increase your chances of interviewing at Fallon Health by 2x
See who you knowGet notified about new Registered Nurse jobs in Worcester, MA.
Sign in to create job alertSimilar jobs
People also viewed
-
RN Registered Nurse
RN Registered Nurse
-
Registered Nurse (RN), Intake Behavioral Health
Registered Nurse (RN), Intake Behavioral Health
-
Registered Nurse (RN), Intake Behavioral Health
Registered Nurse (RN), Intake Behavioral Health
-
Remote Registered Nurse (Remote Patient Monitoring & Chronic Care Management)
Remote Registered Nurse (Remote Patient Monitoring & Chronic Care Management)
-
Registered Nurse (RN)
Registered Nurse (RN)
-
RN (Registered Nurse)
RN (Registered Nurse)
-
RN (Registered Nurse)
RN (Registered Nurse)
-
Remote Registered Nurse (Remote Patient Monitoring & Chronic Care Management)
Remote Registered Nurse (Remote Patient Monitoring & Chronic Care Management)
-
Registered Nurse (RN)
Registered Nurse (RN)
-
RN / Registered Nurse - $60/hr + Day Shift - SSM Health On-Demand - BHS
RN / Registered Nurse - $60/hr + Day Shift - SSM Health On-Demand - BHS
Looking for a job?
Visit the Career Advice Hub to see tips on interviewing and resume writing.
View Career Advice Hub