TMP Quality Performance RN I-Temporary

We appreciate your interest in our organization and assure you that we are sincerely interested in your qualifications. A clear understanding of your background and work history will help us potentially place you in a position that meets your objectives and those of the organization. Qualified applicants are considered for positions without regard to race, color, religion, sex (including pregnancy, childbirth and breastfeeding, or any related medical conditions), national origin, ancestry, age, marital or veteran status, sexual orientation, gender identity, genetic information, gender expression, military status, or the presence of a non-job related medical condition or disability (mental or physical).

**This is a full-time temporary position. If selected, onboarding will be completed through a staffing agency.**
About us
Kern Health Systems is dedicated to improving the health status of our members through an integrated managed health care delivery.
Essential Duties and Responsibilities

• Assist in the implementation of the QP initiatives and functions
• Performs QP activities related to State required Quality requirements
• Serves as knowledge expert for KHS QP activities
• May be required to achieve State certification through the California Department of Health Services as a facility site reviewer and conduct facility site reviews for credentialing and re-credentialing of practitioners and providers. Certification is provided through KHS.
• Performs and documents HEDIS or HEDIS-like medical record reviews to assess compliance with specific measures.
• Participates in problem identification, data analysis, conclusions, recommendations, and action plans.
• Monitors and analyzes outcomes to ensure goals, objectives, outcomes, and regulatory requirements are met.
• Assists in preparation of reports for committees.
• Assists in activities to prioritize QP initiatives.
• Ensures that documentation produced and/or processed complies with State and Federal regulations.
• Assists with training and orientation for new employees.
• Performs all job functions in a safe manner.
• Provides input in support of State and Federal requirements as it pertains to the mandated managed care accountability set (MCAS) measures.
• Maintains the confidentiality of records and reports for both KHS members and contracted providers.
• Performs in-depth medical records reviews as needed and is able to write a professional, clinical summary.
• Knowledge of acute care nursing principles, methods, and commonly used procedures.
• Knowledge of medical terminology, hospital routine; and commonly used medical equipment.
• Knowledge of acute hospital organizations and inter-relationships of various clinical and diagnostic services.
• Performs other job-related duties as required

REQUIREMENTS:
CORE COMPENTENCIES / KNOWLEDGE & SKILL REQUIREMENTS

• Ability to effectively evaluate medical records of hospital admissions regarding continuing stay necessity, appropriateness of setting, delivered care, use of ancillary services and discharge plans.
• Ability to assess and judge the clinical performance of physicians and other health professionals.
• Thorough knowledge of health care delivery systems.
• Knowledge of State and Federal managed care regulatory requirements.
• Ability to read, interpret and apply written regulations, guidelines and other materials.
• Strong analytical, assessment and problem-solving skills.
• Strong people skills, including the ability to establish and maintain effective working relationships with individuals at all levels both inside and outside of KHS.
• Ability to use tact and diplomacy to diffuse emotional situations.
• Effective oral and written communication skills, including the ability to effectively explain complex information and document according to standards.
• Intermediate skills in Word, Excel, PowerPoint, and Outlook, with basic ability to enter data into and navigate through a database.
• Ability to commit to and facilitate an atmosphere of collaboration and teamwork.
• Knowledge of provider documentation requirements and governmental regulations affecting reimbursement.
• Demonstrated ability to respect and maintain the confidentiality of all sensitive documents, records, discussions and other information generated in connection with activities conducted in, or related to, patient healthcare, KHS business or employee information.
• Self-directed, with proven ability to work independently with minimum supervision.
• Uses appropriate judgment and asks questions and seeks assistance appropriately.
• Demonstrated ability to multi-task and complete assignments on a timely basis.
• Strong attention to detail; works accurately and meets expected deadlines and target dates.
• Ability to communicate effectively with contracting physicians, other ancillary providers and internal departments.
• Compliant with KHS policies and procedures.

Employment Standards:
LICENSURE:

• Possession of a valid California Registered Nursing License and in good standing
• Certification in Quality Improvement/Assurance highly desired

EDUCATION:

• Associate Degree in Nursing from an accredited institution or equivalent required; Bachelor of science (BSN) Preferred.

EXPERIENCE:

• Two (2) years of RN experience in a direct patient care setting preferred.
• One (1) year experience in Utilization Management or QI/QP in a healthcare delivery or managed care setting desired.

We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis.