Quality Improvement Nurse Job Description
Quality improvement nurse
provides clinical leadership and support for health plan Quality Improvement programs, including NCQA accreditation initiatives, coordination of HEDIS reporting, CMS Stars, as well as meeting or exceeding all regulatory requirements.
Quality Improvement Nurse Duties & Responsibilities
To write an effective quality improvement nurse job description, begin by listing detailed duties, responsibilities and expectations. We have included quality improvement nurse job description templates that you can modify and use.
Sample responsibilities for this position include:
Identifies quality improvement opportunities and participates in quality improvement initiatives in assigned roles as delegated
Evaluates all data from the chart audits and develops a plan of action for Continuous Quality Improvement
Accurately retrieves data from patient records, direct observation, and other data collection methods for hospital and medical staff quality improvement activities according to accepted specifications and within expected time frames
5 or more years in a variety of nursing settings including 1 year in quality improvement, patient satisfaction, and/or outcomes management
Offices on a regular and ongoing basis in an assigned
Partners with cross-functional teams, including, Sr
Assisting the Performance Improvement Manager in ensuring excellent clinical outcomes and accurate HHRG Coding
Performing review of OASIS assessment and 485 for completeness and accuracy with coding based on ICD and CPT classification systems
Abstraction of patient records according to coding requirements and procedures
Using SHP as tool to review coding
Quality Improvement Nurse Qualifications
Qualifications for a job description may include education, certification, and experience.
Licensing or Certifications for Quality Improvement Nurse
List any licenses or certifications required by the position: CPR, CPHQ, CPC
Education for Quality Improvement Nurse
Typically a job would require a certain level of education.
Employers hiring for the quality improvement nurse job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and Master's Degree in Nursing, Education, Department of Education, Graduate, Nursing Education, Medical Science, Midwifery, Nurse Anesthesia, Health, Healthcare
Skills for Quality Improvement Nurse
Desired skills for quality improvement nurse include:
Process improvement
Quality Improvement
HEDIS/Stars/CMS/Quality
Provider Rewards and MRA Coding
CMS Stars Program elements
Patient Experience and Patient Safety
HEDIS/CMS Stars/Quality
Medicare Risk Adjustment and billing/coding
HEDIS/Stars/CMS
Local and national quality management and regulatory standards
Desired experience for quality improvement nurse includes:
Utilizes computer programs to effectively collect, analyze, present, and communicate data to the various staff of the hospitals
Performs accurate concurrent and retrospective review, as needed to support performance improvement activities in conjunction with the goals and strategic plan of the hospital
Utilizes systematic data collection, aggregation, analysis and reporting techniques to achieve concurrent compliance review of identified quality/patient safety metrics
Routinely performs tracers and observations of clinical practices to assess compliance with established standards and develops methodology to effectively report the findings to the key stakeholders to achieve and maintain the designated compliance/regulatory standard
Assists the Department Director and collaborates with the Department Data Analysts to compile reports for key committees of the hospital
Prepares case review summaries of identified opportunities for improvement related to quality metrics and quality initiatives for presentation to the Triage/Utilization Committee to appropriate nursing stakeholder groups
Quality Improvement Nurse Examples
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Quality Improvement Nurse Job Description
Job Description Example
Our company is growing rapidly and is looking for a quality improvement nurse. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for quality improvement nurse
- Serves as a subject matter expert (SME) to the staff members of the hospitals and acts as a liaison between the various departments, improvement teams and staff members of the hospitals to achieve positive quality outcomes
- Prepares and presents information effectively to internal and external customers of the Clinical Resources Department as needed to support the quality goals of the organization
- Prepares and provides education regarding quality initiatives and/or performance standards to members of the medical and hospital staff as assigned and ongoing, as indicated by measured outcomes/compliance to metrics
- Provides recommendations to modify or improve process/flow of Department
- Recognizes potential Code 15 and/or Sentinel Event cases and reports them to the Risk Manager or designee upon discovery
- Collaborates with Risk Management as appropriate
- Maintains standards in accordance with Joint Commission/Regulatory agencies
- Three (3) – five (5) years Clinical Experience as a Registered Nurse
- Computer literate – database management
- Adaptability to learning new data reporting applications
Qualifications for quality improvement nurse
- Ability to learn and demonstrate proficiency in core measure data abstraction and to perform concurrent data abstraction duties as assigned
- Proficient in development of education programs on relevant quality topics and conducting presentations to professional audiences
- Proficient in data analysis and identification of trends
- Participation in at least 1 Performance Improvement Team
- Minimum of a AS, AA Degree or Equivalent for a RN
- Excellent Communication/Motivational skills(Preferred)
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Quality Improvement Nurse Job Description
Job Description Example
Our company is growing rapidly and is looking to fill the role of quality improvement nurse. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for quality improvement nurse
- Certification in Healthcare Quality(Preferred)
- Serve as a key interface and liaison between DHMG-IE Primary Care Physicians (PCPs) and managed care patients not utilizing referrals and/or receiving needed services
- Pull reports from various health plan websites to identify patients missing services
- From various Health Plan reports, look up patient in the managed care application to confirm no claims received for missing services
- For DHMG-IE employed physician patients only, look up patient in NextGen EMR to determine if services are due (i.e., date of last colonoscopy indicates if colonoscopy now due
- For DHMG-IE Contracted PCP patients, CQI Nurse will be responsible to coordinate with provider’s office and obtain records
- If services are due but not yet provided, call patient to reiterate the need for the patient to have the service(s)
- Assisting and facilitating in the monitoring and evaluating the quality and appropriateness of care/services
- Monitoring member satisfaction
- Participating / managing initiatives for improvement and evaluating the effectiveness of interventions
Qualifications for quality improvement nurse
- Providing consultation and direction internally within the Nurse Care Manager and Quality Department and externally with vendors to ensure programs and services are implemented at the highest standards and patients receive the highest level of care
- Participating in quality assurance, compliance, and risk management
- Experience auditing patients’ medical record for quality/compliance issues
- Active FL RN or FL LPN license
- Conducts data analysis and identifies opportunities for improvement in nursing services and other health care supports
- Develops and implements educational information, materials and programs
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Quality Improvement Nurse Job Description
Job Description Example
Our growing company is looking for a quality improvement nurse. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for quality improvement nurse
- Performs internal audits and inspections to ensure compliance with organization practices and procedures, State and Federal regulations and nursing practice standards
- Two (2) years’ experience in hospital setting
- Florida licensed registered nurse
- Five (5) years’ experience in hospital quality department (Preferred)
- Identify opportunities to improve Stars and Quality processes, methods, team engagement, and present resolution options / cost
- Monitor and investigate all quality of care and collaborates with medical directors to determine impacts and next steps for actions
- Analyze, update, and modify procedures and processes to continually improve QI operations
- Collect and summarize performance data and identify opportunities for improvement
- Monitor and analyze outcomes to ensure goals, objectives, outcomes, accreditation, and regulatory requirements are met
- Participate in site visit preparation and execution by regulatory and accreditation agencies
Qualifications for quality improvement nurse
- Previous Medicare home health experience is strongly preferred
- Ability to travel to local provider offices 3-4 days a week in the Ft
- Must have accessibility to high speed DSL or Cable modem for a home office (Satellite internet service is NOT allowed for this role)
- Minimum of five (5) years of nursing experience in related field, required
- Knowledge of Healthcare Effectiveness Data and Information Set (HEDIS), Quality Assurance Reporting Requirements (QARR), National Committee for Quality Assurance (NCQA) and related, preferred
- Successful completion of an accredited licensed practical nurse program required
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Quality Improvement Nurse Job Description
Job Description Example
Our innovative and growing company is looking for a quality improvement nurse. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for quality improvement nurse
- Investigate and incorporate national best practice interventions to affect greater rate increases
- Perform annual update on Plan Risk Management Program Description
- Coordinate the regular and systematic review of all potential adverse incidents in accordance with state statute
- Screens cases using appropriate criteria and appropriately refers cases to another level of care
- Monitors quality indicators, calculates statistics, analyzes data for trends of improvement and/or areas of concern, and participates in and/or facilitates associated performance improvement activities
- Experience in statistical analysis required
- RN with a minimum of 6 years clinical experience strong electronic medical records background in either the inpatient or outpatient setting knowledge of HEDIS requirements understanding of the Peer Review process and competent in chart review for quality of care issues
- Good communication skills Excellent interpersonal communication skills
- Good PC skills, experience with MS Office programs and other computer applications
- Ability to work as a team member Able to type 30 wpm preferred Good organizational skills
Qualifications for quality improvement nurse
- Current licensure by the State of Michigan as a licensed registered nurse is required
- A minimum of two years clinical medical-surgical experience and prior home care experience required
- Minimum three to five years’ experience in quality, performance improvement or hospital data analytics
- Current LPN or RN license required
- Bachelor's Degree in Healthcare, Nursing, Health Administration, Public Health or a related Health field
- 2 years minimum clinical experience preferably in an acute care, skilled or rehabilitation clinical setting
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Quality Improvement Nurse Job Description
Job Description Example
Our growing company is looking to fill the role of quality improvement nurse. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for quality improvement nurse
- Knowledge of managed care or utilization review or hospital quality
- Good communication skills, Excellent interpersonal communication skills, Good PC skills, experience with MS Office programs and other computer applications
- Willingness to be flexible with job responsibilities Current RN license in Illinois
- Provides leadership and support in establishing and executing the Quality Performance Initiatives in alignment with corporate goals
- Supervises and coordinates the work activities of the team
- Monitors productivity, call center metrics, documentation and call quality to ensure established standards are met
- Collaborates with Quality/Risk Management to investigate and analyze root causes, patterns, or trends that could result in compensatory or sentinel events, serious adverse events, and near misses
- Good communication skills Excellent interpersonal communication skills Good PC skills, experience with MS Office programs and other computer applications Ability to work as a team member and independently
- Good organizational skills Good problem~solving skills Ability to handle difficult calls and maintain professional conduct Willingness to be flexible with job responsibilities
- Collaborate with multidisciplinary team on problem identification and resolution, cost containment issues, implementation of new services and systems/ performance measures
Qualifications for quality improvement nurse
- Experience with children with special healthcare needs strongly preferred
- Demonstrated analytical ability in identifying problems, developing solutions, implementing effective courses of action, and leading project teams
- Strong communication skills required, including the ability to effectively communicate verbally and in writing, internally and externally, and with varied educational levels in mind
- Strong knowledge of MS Office, including large-scale database management required
- Proficiency in Access and SQL preferred
- Knowledge of Lean, Six Sigma, CQI Principles, and Project Management strongly preferred