Senior Specialist, Health Plan Quality Program Management & Performance (RN) - R

JOB DESCRIPTION Job Summary Provides senior level clinical support to quality team - contributing to quality management programs, initiatives, audits, data analysis and quality improvement surveys and state/federal quality compliance activities. Contributes to overarching strategy to provide safe, efficient and cost-effective member care.Essential Job Duties Ensures individual and systemic quality of care investigations are performed timely, accurately, and in accordance with state-based requirements. • Adheres to structure and processes for tracking and trending reportable incidents, quality of care events, member service concerns, and mortalities. • Performs quality monitoring activities, including audits of medical record quality, services and service sites, health and safety, and follow-up monitoring of placement settings. • Monitors and ensures that key quality activities that involve clinical decision-making are completed on time and accurately; presents results to key departmental leadership and other departments as needed. • Implements key quality strategies that require a component of near real-time clinical decision-making. These activities may include initiation and management of interventions (e.g., improving patient safety); preparation and review of potential quality of care and critical incident cases; review of medical record documentation for credentialing and model of care oversight; and any other federal and state required quality activities. • Adheres to w