Registered Nurse (RN) Quality

Location: Birmingham, AL

Work Schedule: Hybrid schedule with some onsite work at the VIVA HEALTH corporate headquarters, some work-from-home opportunities, and some travel to locations within the VIVA HEALTH service area through a reliable means of transportation insured in accordance with Company policy.

Why VIVA HEALTH?

VIVA HEALTH, part of the renowned University of Alabama at Birmingham (UAB) Health System, is a health maintenance organization providing quality, accessible health care. Our employees are a part of the communities they serve and proudly partner with members on their healthcare journeys.

VIVA HEALTH has been recognized by Centers for Medicare & Medicaid Services (CMS) as a high-performing health plan, receiving a 5 out of 5 Star rating - the highest rating a Medicare Advantage Plan can achieve and has been repeatedly ranked as one of the nation's Best Places to Work by Modern Healthcare.

Benefits

• Comprehensive Health, Vision, and Dental Coverage
• 401(k) Savings Plan with company match and immediate vesting
• Paid Time Off (PTO)
• 9 Paid Holidays annually plus a Floating Holiday to use as you choose
• Tuition Assistance
• Flexible Spending Accounts
• Healthcare Reimbursement Account
• Paid Parental Leave
• Community Service Time Off
• Life Insurance and Disability Coverage
• Employee Wellness Program
• Training and Development Programs to develop new skills and reach career goals
• Employee Assistance Program

See more about the benefits of working at Viva Health - https://www.vivahealth.com/careers/benefits

Job Description

The RN, Quality is responsible for activities conducted within the Quality Improvement area that ensure compliance with the Centers for Medicare and Medicaid Services (CMS) or other quality related mandates or objectives which impact VIVA HEALTH STAR ratings and improve member outcomes. The primary responsibilities for this role include timely research and response to potential quality of care grievances, activities in support of HEDIS or other designated quality measures sets and standards (ex:
Medicaid, NCQA), participating in community health fairs, conducting member outreach and health screenings, and may assist with development and execution of VIVA HEALTH ’s field safety program.

Key Responsibilities

• Perform medical record and claims information reviews in compliance with quality measure specifications (HEDIS chart abstraction).
• Collaborate with internal departments to perform member outreach and to engage physician and physician office staff to improve member outcomes.
• Review potential quality of care grievances and track and trend providers/facilities and report outcomes.
• Support member and provider interactions by assisting member access to necessary services, perform routine screenings and member education, and facilitate community health fairs and other wellness events.
• Monitor regulatory guidelines published by the Center for Medicare Services (CMS), Occupational Safety and Health Administration (OSHA) guidelines, National Committee for Quality Assurance (NCQA) and others relevant to areas of responsibility.

REQUIRED:

• Graduate of an accredited program of professional nursing, ADN/BSN
• 1 year of experience in a health care quality management/ improvement related function
• Current RN License in good standing with the State of Alabama Board of Nursing
• Valid driver’s license in good standing
• CPR Certification
• May require significant face-to-face member contact, with duties regularly performed away from the principal place of business
• Willing to submit to vaccine testing and screening
• Knowledge of medical conditions, treatment, documentation and practice standards which may include demonstration of clinical competency in performing wellness screenings such as finger sticks, bone density heel scans, and blood pressures
• Ability to organize ideas and communicate written and oral messages appropriate to listeners and situations
• Ability to develop project plans, problem solve and engage others to achieve department and company strategic goals, which may require staff training, networking, and strategic planning
• Ability to think analytically with demonstrated skills in interpreting health care data and medical information and identifying/implementing quality improvement strategies
• Ability to work under pressure to meet deadlines with minimal supervision
• Skilled at communicating and interacting professionally and courteously both in person and on the phone with a diverse population
• Skilled use of personal computers and related software such as Microsoft Office suite of products

PREFERRED:

• Bachelor’s degree in nursing or other health-related field
• Experience in Managed Care
• Experience in a community based clinical role, such as home health
• Experience in HEDIS chart abstraction and data management tools
• Working knowledge of health care coding and insurance
• Ability to perform data analysis using a variety of systems and databases
• Knowledge and understanding of Medicare Advantage STARs rating components, especially HEDIS
• Knowledge of risk assessment and writing policies and procedures
• Skilled at medical chart review and assessment of compliance with established standards