Job Description

Job Description

Job Description

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The Company:

AlohaCare is a local, non-profit health plan serving the Medicaid and Medicare dual eligible population. We provide comprehensive managed care to qualifying health plan members through well-established partnerships with quality health care providers and community-governed health centers. Our mission is to serve individuals and communities in the true spirit of aloha by ensuring and advocating access to quality health care for all. This is accomplished with emphasis on prevention and primary care through community health centers that founded us and continue to guide us as well as with others that share our commitment. As Hawaii’s third-largest health plan, AlohaCare offers comprehensive prevention, primary and specialty care coverage in order to successfully build a healthy Hawaii .

The Culture:

AlohaCare employees share a passion for helping Hawaii’s most underserved communities. This passion for helping and caring for others is internalized and applied to our employees through a supportive and positive work environment, healthy work/life balance, continuous communication and a generous benefits package.

AlohaCare’s leadership empowers and engages its employees through frequent diversity, recognition, community, and educational events and programs. AlohaCare has a strong commitment to support Hawaii’s families and reinforces a healthy work/home balance for its employees. Because AlohaCare values honesty, respect and trust with both our internal and external customers, we encourage open-door, two-way communication through daily interactions, employee events and quarterly all-staff meetings. AlohaCare’s comprehensive benefits package includes low cost medical, dental, drug and vision insurance, PTO program, 401k employer contribution, referral bonus and pretax transportation and parking program.

These employee-focused efforts contribute to a friendly, team-oriented culture which is positively reflected into the communities we serve.

The Opportunity:

Job Summary:

The Quality Improvement Nurse will be responsible for ensuring the highest standards are met when performing quality improvement activities. This role involves working closely with administrators, staff and providers to promote and ensure quality of care and quality of service to AlohaCare members. The Quality Improvement Nurse performs under the direction and guidance of the Quality Program Manager or other Quality Improvement leadership.

Primary Duties and Responsibilities:

• Analyze data to identify trends, areas of improvement, and the effectiveness of interventions
• Develop and implement strategies to improve member outcomes and enhance overall quality of care
• Ensure compliance with local, state and federal regulations, as well as accreditation standards
• Assists providers and AlohaCare staff with training and education in standards, policies, procedures, programs, resources, etc. related to AlohaCare’s Quality Improvement activities.
• Helps AlohaCare members with QI activities, when applicable
• Assists with orientation and training of new QI Department employees in collaboration with the QI Department leadership.
• Supports QI activities, including but not limited to:
  • Audits
  • Medical record review
  • Prepare and present reports on quality metrics findings and improvement activities
  • Policies and procedures
  • Committees and workgroups (internal and external)
  • Clinical Practice Guidelines
  • HEDIS
  • NCQA Accreditation
  • Potential Quality of Care issues/Adverse Events
  • Performance Improvement Projects
  • Other duties as assigned
• Work with interdisciplinary teams to design and execute quality improvement projects
• Support quality activities of internal departments (i.e., Credentialing, Health Services, Grievance and Appeals, PHM, etc.)
• Responsible for maintaining AlohaCare’s confidential information in accordance with AlohaCare policies, and state and federal laws, rules and regulations regarding confidentiality. Employees have access to AlohaCare data based on the data classification assigned to this job title.
• Other job-related duties as assigned by Quality Improvement leadership.

Requirements:

• Associate’s degree in nursing
• Minimum of 2 years of clinical experience.
• Demonstrates ability for assessment, evaluation and interpretation of clinical information.
• Ability to work independently with minimum supervision.
• Demonstrates the ability to work well with members, physicians and other health care providers.
• Exhibits strong planning, organization, and analytical, and time management skills.
• Must be able to communicate clearly (verbally and in writing) across departments and to members and providers to facilitate action plans.
• Basic computer knowledge, data analysis and competence with spreadsheet and database programs
• Intermediate computer PC skills, including the use of Microsoft Office software
• Excellent written and verbal communication skills.
• Effective organizational skills with ability to multi-task
• Familiarity with healthcare regulations and accreditation standards

Required Licensure / Certification:

• Current and unrestricted Registered Nurse (RN), licensed in the State of Hawaii.
• Current valid State of Hawaii Drivers’ License and access to reliable, 4-wheel safety inspected and insured vehicle

Preferred Competencies and Qualifications:

• Minimum three years clinical experience; experience in an acute care setting desirable.
• Knowledge of QI/QA principles and methodology, health care/social research methodology, and ICD-9, ICD-10 and CPT codes desirable.
• Previous experience in a managed care environment desirable.

Equipment/Resources Used:

• Computer workstation computer printer, copier, fax machine, telephone.
• AlohaCare Policy and Procedure Manual
• QUEST Policy and Procedure Manual
• CMS/Medicare/NCQA Standards

Mental, Physical and Environmental Demands:

• Ability to travel frequently on all islands throughout the State of Hawaii, including ground and air travel.

· May require prolonged sitting- up to 4 hours

· Requires operation of a computer workstation, including keyboard and video display terminal.

· Ability to communicate via telephone and within a group

· May require occasional lifting, up to 20 pounds.

· Requires verbal and written communication in English with members and providers

· Work in a high stress environment at times, with pressure of multiple deadlines

· Requires frequent travel throughout the state of Hawaii, including on Oahu and Neighbor Islands to conduct quality reviews or provider training. Own transportation necessary to meet off-site travel requirements.

Salary Range: $78,000 - $85,000 annually

AlohaCare is committed to providing equal employment opportunity to all applicants in accordance with sound practices and federal and state laws. Our policy prohibits discrimination and harassment because of race, color, religion, sex (including gender identity or expression), pregnancy, age, national origin, ancestry, marital status, arrest and court record, disability, genetic information, sexual orientation, domestic or sexual violence victim status, credit history, citizenship status, military/veterans’ status, or other characteristics protected under applicable state and federal laws, regulations, and/or executive orders.

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