Head Nurse - Quality Improvement - Home Care jobs in Washington

Head Nurse - Quality Improvement - Home Care develops and implements various activities to improve overall quality of organization. Participates in and serves as a resource to quality improvement committees. Being a Head Nurse - Quality Improvement - Home Care tracks and analyzes trends and outcome reports and advises management on areas to improve upon. May be responsible to ensure all institute or government regulations are adhered to. Additionally, Head Nurse - Quality Improvement - Home Care requires a bachelor's degree. Typically reports to top management. The Head Nurse - Quality Improvement - Home Care supervises a group of primarily para-professional level staffs. May also be a level above a supervisor within high volume administrative/ production environments. Makes day-to-day decisions within or for a group/small department. Has some authority for personnel actions. Thorough knowledge of department processes. To be a Head Nurse - Quality Improvement - Home Care typically requires 3-5 years experience in the related area as an individual contributor. (Copyright 2024 Salary.com)

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Quality Improvement Nurse (ONC/MPD)
  • State of Washington Health Care Authority
  • Olympia, WA FULL_TIME
  • Description

    Quality Improvement Nurse (ONC/MPD)
    71103653

    Join us in revolutionizing healthcare quality as an Occupational Nurse Consultant! This pivotal role is dedicated to ensuring compliance and excellence in hospital-related payments, while also serving on our external quality review team. With your clinical expertise, you’ll lead quality improvement initiatives, monitor contracts, and ensure the timely delivery of exceptional care within our Medicaid managed system. Be at the forefront of driving impactful change in healthcare outcomes while ensuring adherence to Federal regulations and fostering a culture of continuous improvement!

    All HCA employees will apply an equity lens to their work, which may include but is not limited to all analyses of core business and processes
    .

    About the division:
    The Mission of Medicaid Programs Division (MPD) in the Health Care Authority (HCA) is to provide high quality health care through innovative health policies and purchasing strategies which assist in the purchase and delivery of health care services to qualified Washington citizens. MPD staff work across the agency and between agencies (Department of Health, Department of Social and Health Services, etc.) and in partnership with health care providers and community stakeholders to develop and manage high-quality, evidence-based, health care programs and purchasing of services that enhance clients’ ability to access appropriate, quality health care. MPD is responsible for the implementation and oversight of Washington Apple Health managed care programs serving over 1.5 million Washington residents in all 39 counties.

    About the position:

    This Quality Improvement Nurse position reports directly to the Analytics, Review, Oversight, and Coordination (AROC) Unit Supervisor within the Quality Oversight and Program Alignment (QOPA) Section in the Division of MPD. The purpose of this Occupational Nurse Consultant position is overseeing the quality-focused compliance for hospital-related payments. This position will serve on the agency’s External Quality Review (EQR) team in order to support cohesiveness of State Directed Payments (SDP) within the Medicaid Managed Care Quality Strategy. This position uses clinical expertise and judgment to perform quality improvement and contract monitoring functions, support the contracted External Quality Review Organization (EQRO), and the quality and timeliness of care and services provided to clients within the Apple Health managed care delivery system.

    This position is eligible to telework part-time but may be required to report on-site to meet business needs.
    The default assigned work location of all Health Care Authority (HCA) positions – both on-site and telework eligible positions – is within the State of Washington. Frequency of onsite work will vary based on business and operational needs. HCA may choose, but is not required, to support out-of-state telework on a case-by-case basis.

    Duties

    Some of what you will do:
    • Identify the areas of clinical care impacted by the statewide State Directed Payment (SDP) strategy, scope, providers included/excluded, and care and services impacted.
    • Identification and recommendation of quality performance measures specific to the scope of the SDP and applicable to the care delivered.
    • Ensure federal compliance for quality measure selection, including identification of CMS Core Measures, use of MCO contracted measures when appropriate, and assurance that billing codes and services are captured within the measure selected.
    • Serve as the agency’s representative in stakeholder meetings for quality aspects of SDP, including representation of agency quality priorities, obtaining stakeholder feedback in the process, addressing concerns, engaging stakeholders in quality improvement, and providing updated data to support quality improvements and evaluation of the strategy. Stakeholders may include MCOs, provider associations, providers, etc.
    • Coordinate with stakeholder, MCO, and agency quality partners to support quality initiatives in alignment with agency and legislative direction, as appropriate. Facilitate agency approval of quality initiatives through the agency's quality committee.
    • Lead and facilitate SDP Quality Workgroup.
    • Coordination with data team to support production of measure specific to SDP provider and enrollee population meeting SDP evaluation submission timeline.
    • Annual evaluation of performance, review within SDP Workgroup, QMMI, and Quality Strategy Workgroup with appropriate stakeholder feedback.
    • Submission of evaluation to CMS with quality metrics explanation for strategy, link to Quality Strategy, and change from statewide approach to CMS-compliant approach.
    • Alignment of MCO and EQRO contracts for use and reporting of SDP measures.
    • Messaging to MCOs for SDP measures, inclusion in QAPI evaluations and provider relations work.
    • Reporting out of evaluation of the Quality Strategy through EQRO's Technical Report, including EQRO contract and deliverables oversight.
    • Serve as back up for clinical oversight of EQRO, including tracking of deliverables, budget, and agency-required responses to meet federal regulations. Represent agency needs and interests in work with EQRO. Communicate EQRO status and work to supervisor to support agency initiatives.
    • Use clinical judgment and expertise to review proposed legislation with potential clinical implications. Provide written narrative analysis as part of review of legislation; coordinate with section staff.

    Qualifications

    Required qualifications:

    • A valid Washington State license to practice as a registered professional nurse. AND Three (3) years of clinical or functional nursing experience.

    AND
    • Two (2) years of consultative, administrative, or supervisory experience over registered nursing staff or other health care professionals.

    Note:
    A bachelor’s degree will substitute for the two years of administrative, consultative or supervisory experience.

    Note:
    A master’s degree in a health care field will substitute for one year of nursing experience.

    Required Competencies (knowledge, skills, abilities and behaviors):
    • Ability to analyze and resolve complex problems.
    • Ability to independently manage competing timelines to meet critical deadlines and handle multiple projects at a time.
    • Ability to write clear, narrative, analytical reports.

    Preferred qualifications:

    • Two (2) years’ experience in quality assurance and improvement principles and approaches.
    • Experience in Medicaid managed care operations.
    • Knowledge in National Committee for Quality Assurance (NCQA) Compliance Audit process and accreditation standards for Medicaid Health Plans.
    • Knowledge in Healthcare Effectiveness Data and Information Set (HEDIS®) measures and audit process.
    • Knowledge in Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Survey measures and process.
    • Experience in contract management and accountability, procurement, contracting using outcomes-focused performance measures.

    Working knowledge of:
    • State and federal laws, policies, regulations and procedures on Medicaid and healthcare. Contract terms and processes.
    • Managed care operations, delivery systems, and customer service.
    • Program development, implementation, and evaluation.
    • Care needs of low income, vulnerable Medicaid recipients in Washington State

    How to apply:


    Only candidates who reflect the minimum qualifications on their NEOGOV profile will be considered. Failure to follow the application instructions below may lead to disqualification. To apply for this position, you will need to complete your profile which includes three professional references and attach:

    • A cover letter that specifically addresses how you meet the qualifications for this position.
    • Current resume

    To take advantage of veteran preference, please do the following:
    • Attach a copy of your DD214 (Member 4 long-form copy), NGB 22, or USDVA signed verification of service letter.
    • Please black out any PII (personally identifiable information) data such as social security numbers. Include your name as it appears on your application in careers.wa.gov.

    Supplemental Information

    About HCA:
    Functioning as both the state's largest health care purchaser and its behavioral health authority, the Washington State Health Care Authority (HCA) is a leader in ensuring Washington residents have the opportunity to be as healthy as possible.

    There are three pillars of our work: Apple Health (Medicaid); the Public Employees Benefits Board (PEBB) and School Employees Benefits Board (SEBB) programs; and behavioral health and recovery. Under these pillars, HCA purchases health care, including behavioral health treatment for more than 2.7 million Washington residents and provides behavioral health prevention, crisis, and recovery supports to all Washington residents.

    What we have to offer:
    • Meaningful work with friendly co-workers who care about those we serve Voices of HCA
    • A clear agency mission that drives our work and is person-centered HCA's Mission, Vision & Values
    • A healthy work/life balance, including alternative/flexible schedules and mobile work options.
    • A great total compensation and benefit package WA State Government Benefits
    • A safe, pleasant workplace in a convenient location with restaurants, and shopping nearby.
    • Tuition reimbursement
    • And free parking!

    Notes:

    Prior to a new hire, a background check including criminal record history will be conducted. Information from the background check will not necessarily preclude employment.

    HCA is an equal opportunity employer. We value the importance of creating an environment in which all employees can feel respected, included, and empowered to bring unique ideas to the agency. HCA has five employee resource groups (ERGs). ERGs are voluntary, employee-led groups whose aim is to foster a diverse, inclusive workplace aligned with HCA’s mission. Our diversity and inclusion efforts include embracing different cultures, backgrounds and viewpoints while fostering growth and advancement in the workplace. Studies have shown women, racial and ethnic minorities, persons of disability, persons over 40 years of age, disabled and Vietnam era veterans, as well as people of all sexual orientations and gender identities are less likely to apply for jobs unless they feel they meet every qualification as described in a job description. If you have any questions about the required qualifications or how your experience relates to them, please contact us at HCAjobs@hca.wa.gov. Persons with disabilities needing assistance in the application process, or those needing this job announcement in an alternative format may contact Julie Laney at (360) 725.5130 or julie.laney@hca.wa.gov.

    The Washington State Health Care Authority (HCA) is an E-Verify employer. All applicants with a legal right to work in the United States are encouraged to apply.

    E-Verify® is a registered trademark of the U.S. Department of Homeland Security.

    Subscribe to our weekly newsletter to receive a list of new job postings at HCA.

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Washington (/ˈwɒʃɪŋtən/), officially the State of Washington, is a state in the Pacific Northwest region of the United States. Washington is the northwestern-most state of the contiguous United States. It borders Idaho to the east, bounded mostly by the meridian running north from the confluence of the Snake River and Clearwater River (about 116°57' west), except for the southernmost section where the border follows the Snake River. Oregon is to the south, with the Columbia River forming the western part and the 46th parallel forming the eastern part of the Oregon-Washington border. To the wes...
Source: Wikipedia (as of 04/17/2019). Read more from Wikipedia
Income Estimation for Head Nurse - Quality Improvement - Home Care jobs
$72,105 to $87,796