Quality Reviewer/Auditor

Provides consultative services and manages quality improvement activities and initiatives for VNSNY CHOICE Health Plans. Contributes to the development of whole system measures and annual Enterprise quality strategic plan. Implements, monitors, and evaluates quality improvement strategies based on national benchmark data to achieve top decile performance. Analyzes performance and recommends improvement initiatives and/or corrective actions. Utilizes quality improvement framework, Plan, Do, Study, Act, to facilitate rapid cycle improvement strategies. Serves as a resource to quality improvement committees and work groups. Integrates compliance and regulatory requirements into QI processes. Works under general direction

• Collaborates with clinical management to identify, develop and implement quality improvement standards and criteria that meet program goals. Evaluates effectiveness of standards and recommends changes, as needed.
• Ensures Quality Improvement programs are aligned with CMS Triple Aim framework: improving the patients experience of care (including quality and satisfaction), improving the health of populations, and reducing the per capita cost of healthcare.
• Establishes and communicates protocols and standards of care for a cultural and demographic diverse patient/member population; provides intervention guidelines based on these population health needs.
• Coaches and facilitates performance improvement activities designed to help teams and programs meet and exceed quality scorecard indicators. Instructs management and staff in the meaning and use of data for the purpose of assessing and improving quality.

Qualifications

• Licensure: License and current registration to practice as a registered professional nurse, preferably in New York State, required.
• Education: Bachelors degree in health care administration, human services or business administration or related discipline or the equivalent work experience in a related professional field required.
• Experience: Minimum of four years clinical experience in a health care setting, including at least two years with a focus on quality improvement and measurement, required. Knowledge of health care delivery systems, patient care, care coordination, and clinical processes required. Ability to perform statistical/quantitative analysis required. Excellent oral, written and interpersonal communication skills required. Knowledge of basic Performance Improvement tools and methodologies preferred.