A licensed professional (RN and-or LVN) nurse having primary responsibility for Quality Improvement activities mandated by NCQA, health Plan and Corporate (HPN).
- Will accomplish chart review activities (Continuity of Care, CPG Audits, Ambulatory Record Review and Annual HEDIS Data Collection per Quality Improvement Work Plan and special projects as needed.
- Will understand use of audit tools and use appropriately.
- Conduct QI On-Site audit of Ancillary Facilities, offices of PCP's, OB GYN and Behavioral Health Specialists, as necessary, including annual patient safety audit of PCP's.
- Will assist QI Nurse Analyst with the summarization of reports above.
- Will be responsible for being familiar with QI programs, QI Activity Calendar and Work Plan. Utilizing various data matrix forms to schedule work activities to meet Departments goals and deadlines.
- Will participate in ongoing PCP-staff education regarding QI Activities, including compliance to policy and procedures, as well as State, Federal and other regulatory agency standards.
- Will bring to QI Director's attention any identified trends, patterns, or concerns.
- Work independently with a minimum of supervision.
- Performs other duties as assigned.
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