Offer summary

Qualifications:

BSN degree required., 3-5 years of healthcare experience, preferably in quality improvement or care management., Registered Nurse licensure required; CPHQ certification preferred., Strong analytical, communication, and MS Office skills, with knowledge of quality standards like NCQA and HEDIS..

Key responsibilities:

Implement and oversee the Quality Management Work Plan for Cook Childrens Health Plans.

Conduct clinical quality reviews and identify issues within the health plan.

Collaborate with healthcare staff and providers to improve clinical quality.

Support compliance with regulatory standards and reporting requirements.

Job description

Location:

Calmont Operations Building

Department:

Quality

Shift:

First Shift (United States of America)

Standard Weekly Hours:

Summary:

The QI Nurse Coordinator serves as the primary staff member accountable for the daily implementation of Cook Childrens Health Plans (CCHP) Quality Management Work Plan. Specifically, the Coordinator completes concurrent and retrospective reviews of clinical quality and issues within the health plan. This position works closely with the CCHP Director of Quality Improvement, Quality Program Lead, Medical Director, other health plan staff, network physicians and other providers to identify clinical quality issues and recommend actions for improvement.

Additional Information:

BSN required.
3-5 years experience in the healthcare field; experience quality improvement, utilization management, or care management in a managed care setting.
Experience with children with special healthcare needs strongly preferred.
Knowledge of local and national quality management and regulatory standards, including NCQA and HEDIS reporting.
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 largescale database management required; Proficiency in Access and SQL preferred.
Knowledge of Lean, Six Sigma, CQI Principles, and Project Management strongly preferred.

Certification/Licensure:

Registered Nurse required.
CPHQ preferred.

About Us:

Cook Children's Health Plan

Cook Children's Health Plan provides vital coverage to nearly 120,000 people in low-income families who qualify for government-sponsored programs in our six county service region. Cook Children's Health Plan provides health coverage for CHIP, CHIP Perinatal, STAR (Medicaid) and STAR Kids Members in the Tarrant county service area. The counties we serve includes Tarrant, Johnson, Denton, Parker, Hood and Wise.

Cook Children’s is an equal opportunity employer. As such, Cook Children’s offers equal employment opportunities without regard to race, color, religion, sex, age, national origin, physical or mental disability, pregnancy, protected veteran status, genetic information, or any other protected class in accordance with applicable federal laws. These opportunities include terms, conditions and privileges of employment, including but not limited to hiring, job placement, training, compensation, discipline, advancement and termination.

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