Clinical Quality Management RN

Company: The Judge Group ( Learn More )

General Information
Not Specified
3 to 5 years
Not Specified
Job Description Judge Healthcare is currently seeking a Clinical Quality Management Registered Nurse (RN) for a contract to hire role located in Wilmington, DE!

This job will have the following responsibilities:
  • Working with appropriate departments in the areas of compliance, process improvement, project management, and member/provider satisfaction for Delaware Medicaid
  • Reviews, researches and responds to customer complaints relating to quality of medical care and service
  • Recommends and/or implements process improvements related to the potential of quality medical care and service
  • Serves as a resource regarding accreditation standards including NCQA standards and continuous quality improvement principles
  • Coordinates committee functions and assists with policy creation and revision
  • Performs special studies per audits and leads performance improvement projects
  • Develops and conducts member education activities and contributes to provider education activities
  • Attends and votes in member appeal hearings.
  • Conduct annual audits, identify gaps, communicate results and re-audit.

  • Qualifications & Requirements:
  • Registered Nurse with current DE RN license
  • Managed Care, Health Plan background highly preferred
  • 3-5 years of relevant, progressive experience in the area of specialization
  • Understanding of Total Quality Management (TQM) concepts, techniques, process and outcome measurements ( 1-2 years)
  • An understanding of statistics is also preferred in order to analyze various reports and validate study methodologies (1-2 years)
  • Excellent verbal communication skills and professional manner along with excellent written communication skills
  • Must be able to communicate with medical administrators, including Medical Directors and Physician Advisors related to problem identification, action plan implementation, ongoing monitoring and problem resolution
  • 1-3 years of demonstrated working knowledge of Microsoft Office software (Word, Excel, Access, PowerPoint, etc.)
  • Well-developed, analytical and problem solving skills with the ability to understand and interpret clinical data

  • If you are interested and qualified for this role, I urge you to apply now or send your most up to date resume to [Click Here to Email Your Resum√©]
    Thank you!Christian McLaughlin
    Job Requirements