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Quality Assessment Performance Improvement (QAPI) RN

    • Job Tracking ID: 512689-588736
    • Job Location: Milwaukee, WI
    • Job Level: Mid Career (2+ years)
    • Level of Education: BA/BS
    • Job Type: Full-Time/Regular
    • Date Updated: September 08, 2017
    • Years of Experience: 2 - 5 Years
    • Starting Date: ASAP
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Job Description:

Perform duties to support optimized performance on key quality indicators including, but not limited to, HEDIS, 5 Star, Pay-for-Performance (P4P), satisfaction surveys, Annual Quality Reviews (AQR), and External Quality Reviews (EQR).  Apply continuous quality improvement strategies across all business lines to improve the quality of iCare’s Medicare, Medicaid, and Long-Term Care programs.  The QAPI Nurse fosters a culture of quality improvement by designing projects and studies in collaboration with appropriate teams that directly impacts iCare members by ensuring data accuracy in reporting, investigation, auditing, and improvement opportunities. 

  1. Assist with the overall Quality Assessment Performance Improvement (QAPI) program for Independent Care Health Plan (iCare), including compliance with State, Federal, and other managed care regulatory bodies, QAPI mandates, audits, performance improvement projects and reports. 

  2. Use continuous Quality Improvement process through tracking and trending data including clinical analysis and reporting for quality monitoring and improvement.

  3. Ensure data integrity/maintain efficiency of data collection/maintenance systems.

  4. Support the entirety of the HEDIS medical record review process to identify targeted measures and other key performance indicators to support optimum quality metric reporting.

  5. Provide clinical direction as needed to staff dedicated to grievance/appeals and credentialing/re-credentialing functions; and as needed to staff dedicated to review, analysis and response to quality concerns, reportable incidents, and statements of deficiency.

  6. Assist with and provide clinical direction as needed to design, implement, and analyze mandated quality and performance improvement projects.

  7. Assist department director in the development, maintenance, and execution of quality documents including work plan, evaluation, program description, and Model of Care (as appropriate for Medicare).

  8. Support the entirety of the HEDIS medical record chase to support optimum HEDIS and quality metric reporting

 

 

Experience and Skills:

  1. State of Wisconsin licensed RN. Bachelor’s degree (BSN) is preferred.

  2. Knowledge of physical and mental impairments and related medical conditions.

  3. Proficiency with PC- based systems and the ability to learn new information systems and software programs.

  4. Prior work experience with and knowledge of both Medicare and Medicaid preferred.

  5. Experience with data collection, analysis and reporting and working with the continuous Quality Improvement process preferred.

  6. Ability to interact effectively with healthcare providers.

  7. Ability to effectively communicate thoughts, ideas and information both orally and in writing.

  8. Ability to demonstrate flexibility, set priorities with daily demands and long term work assignments and projects. Ability and willingness to change priorities when necessary.

  9. Strong interpersonal skills and ability to effectively interact with members and co-workers from a variety of different backgrounds and experiences in a professional, diplomatic and courteous manner.

  10. Ability to work effectively as a team member and cooperate in achieving company goals.

  11. Skill and ability to seek solutions using appropriate methodologies. Problem solving ability to apply an appropriate combination of independent thinking, consultation with relevant staff and the collection of facts to track, trend and interpret data.

  12. A personal vehicle, valid State of Wisconsin motor vehicle operator’s license and conformity with insurance coverage limits is also required.


 

 
 
 
  • Independent Care Health Plan
  • 1555 RiverCenter Drive, Suite 206
  • Milwaukee, WI 53212
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