Full Benefits, Medical, Dental, Vision, Retirement
Internal Number: 1737
Our Mission.. Kern Health Systems is dedicated to improving the health status of our members through an integrated managed health care delivery system
PRIMARY PURPOSE
Under the direction of the Manager of QI, the QI Supervisor RN is responsible for supervising the day-to-day operations and activities for appropriate clinical and non-clinical staff within the QI Department, including oversight of all clinical Grievances, Potential Quality Issues (PQIs), Performance Improvement Projects (PIPs), and any other relevant clinical or non-clinical activities. The QI RN Supervisor works in a coordinated effort with the QI Manager to ensure productive and efficient operations. The QI RN Supervisor works closely with the QI Senior Analyst and Trainer and QI Manager for coordination of training and orientation of new staff in QI processes and procedures.
MAJOR DUTIES AND RESPONSIBILITIES
Supervises the non-clinical and appropriate clinical staff to ensure compliance with department processes and KHS policies and procedures.
Performs routine clinical audits for Potential Quality Issue (PQI) investigations, Grievance reviews, and Initial Health Assessment compliance
Monitors and reports production and quality of work by assigned QI staff using data and reports.
In coordination with the QI Manager, establishes productivity benchmark performance goals for staff
Works with staff to achieve production, timeliness, accuracy, and quality of work
Reviews and resolves provider, member, or KHS department complaints and escalates issues to higher level management if necessary
Provides assistance and oversight of clinical staff regarding design, methodology, data analysis and reporting of Quality performance improvement projects.
In Coordination with the QI Senior Analyst and Trainer, coordinates an orientation program for new QI Department staff.
Responsible for payroll activities, including approval of timecards, PTO, and flex requests for QI staff
Supervises and evaluates performance of appropriate QI staff
Maintains a knowledge base of HEDIS/MCAS requirements and participates in planning and activities to improve HEDIS/MCAS performance
Participates in the development, review, and updating of policies and procedures
In coordination with management, assists in process improvement initiatives for the betterment of KHS and KHS members
Maintains the confidentiality of records and reports for the both the membership of KHS and the contract providers
Assists with the implementation of new systems to be used in the QI Department.
Assists with and may lead implementation of new systems used in the QI Department
Remains current with Department of Health Care Services and Department of Managed Care policy implementation or revisions
Performs other job-related duties as required
Adheres to all company policies and procedures related to employment and job responsibilities
Knowledge of with industry standard Quality Improvement processes
Responsible for creation, updating and training of QI clinical processes, functions, tools, and resources
Ability to read, interpret and apply written regulations, guidelines, and other materials
Thorough knowledge of medical terminology and commonly used equipment
Strong analytical, assessment and problem-solving skills
Strong interpersonal skills, including the ability to establish and maintain effective working relationships with individuals at all levels both inside and outside of KHS
effectively manage both clinical and non-clinical staff in support of individual and team success
Ability to use tact and diplomacy to diffuse emotional situations
Effective oral and written communication skills, including the ability to effectively explain complex information and document according to standards
Intermediate skills in Word, PowerPoint, Excel, and Outlook with basic ability to enter data into and navigate through a database
Maintains confidentiality of all sensitive documents, records, discussions, and other information generated in connection with activities conducted in, or related to, patient healthcare, KHS business, or employee information
Self-directed and able to work independently. Uses appropriate judgment to seek assistance and ask questions
Updates Manager of QI on day-to day activities, issues identified, and actions to address issues
Operates with target dates and deadlines and meets deadlines with successful outcomes. Appropriately negotiates changes to target dates and holds staff accountable similarly to target dates
Strong attention to detail and work accuracy
EDUCATION, EXPERIENCE, AND TRAINING REQUIRED
Associates Degree in Nursing required; Bachelor’s Degree in Nursing preferred
Five (5) years of experience in the direct patient care setting and one (1) year of experience in health care Quality Improvement, and two (2) years of management and operations management, experience
Working knowledge of State and Federal regulatory requirements, particularly related to QI activities, or ability to readily learn and apply this information
OTHER REQUIREMENTS
Registered nurse with an active license in good standing with the State of California
Certified Professional in Healthcare Quality (CPHQ) preferred
Possess a valid California Driver’s License with transportation and automobile liability insurance limits acceptable to KHS. Up to 25% driving.
Kern Health Systems, known as Kern Family Health Care, was established in 1993 as a managed care health plan, and is the largest health plan in Kern County. Kern Health Systems is committed to providing quality health care to our members. It is important to ensure good health through continuity of care by connecting each member to a provider of their choice within our provider network. Our extensive provider network includes the Traditional and Safety-Net Providers that historically delivered care to Medi-Cal recipients and private providers throughout Kern County and some parts of Los Angeles County. We believe good patient/physician relationships and effective preventive care are true indicators of our success. We also offer a continuum of care that extends beyond doctor visits. With a full range of health education classes and Care/Disease Management programs, we provide quality educational and preventive services to the population we serve. We are able to achieve this through partnerships with our providers and community-based organizations within Kern County. The difference is clear: We hold the standard high when it comes to quality health care for our members. Our Missio...n… Kern Health Systems is dedicated to improving the health status of our members through an integrated managed health care delivery system. As Kern Health Systems continues to move forward, we will continue to uphold our mission of being dedicated to improving the health status of our members through an integrated managed healthcare delivery system. As the healthcare landscape has been transformed, we will pursue tomorrow with community and provider innovation, enhanced member access, and strengthened member health and wellbeing...Together.
