Quality Management Specialist II


Website Administrative

Reference Code: 4642

Position:  Quality Management Specialist II
Duration: 01/25/2021 to 03/31/2021
Location Address: 4411 The 25 Way NE Albuquerque New Mexico 87109 United States


This is a long term position and the plan is to convert if a good fit. The driver’s license can be any state as long as it’s valid, no driving during the pandemic – the position will be work from home until we transition back to the office in the spring.

The Quality Management Specialist II performing the function of Critical Incident Coordinator:
1. Responds to and conducts resulting follow-up activities to related Critical Incidents; and
2. Is responsible for facilitating and monitoring of assigned quality improvement projects, including the following:
* Consult with network physicians, Medical Group/IPAs, providers, staff, members, and other resources, as appropriate, to assess, plan, facilitate implement, coordinate, monitor and evaluate options to meet clinical quality improvement project objectives and to promote high quality and cost effective outcomes.
* Gather information, analyzes and communicates it, and develops recommendations regarding clinical quality improvement projects.
* Assist in addressing issues related to clinical quality improvement projects for the managed care programs to assure compliance with contractual arrangements, accreditation requirements, government regulations and employer group expectations.
* Assist in coordinating internal support functions for assigned clinical quality improvement projects.
* Analyze statistical reports to evaluate effectiveness of quality improvement projects as well as to identify opportunities for improvement.
* Cooperate with other members of the department and interfacing departments as a team to increase overall efficiencies in an effort to maintain or decrease administrative costs.
* Provide ongoing documentation of clinical quality improvement project interventions for quarterly and annual Quality Improvement Reports, and for accreditation reviews ensuring reporting accuracy and timeliness.
* Present clinical quality improvement project results to the Quality Improvement Workgroups and Managed Care QI Committees.
3. Functions as preceptor for orientation of new employees.
4. Coordinates and provides interface with medical groups and other practitioners regarding existing and proposed clinical quality improvement initiatives.
5. Assists in meeting and interfacing with outside agencies and organizations such as the New Mexico Human Services Department, Adult Protective Services, Children Youth and Families Department, etc.
6. Maintains and enhances knowledge of clinical nursing and regulatory standards by attending seminars, training sessions, etc.
7. Attends internal/external meetings to keep apprised of quality improvement and managed care issues/information.
8. Assists in day-to-day activities in an effort to achieve QI annual divisional goals.
9. Practices within the scope of licensure and/or certification and accreditation standards.
10. Communicates and interacts effectively and professionally with co-workers, management, customers, etc.
11. Complies with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.
12. Maintains complete confidentiality of company business.
13. Maintains communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested.

* Registered Nurse (RN), Licensed Practical Nurse (LPN), Respiratory Therapist, or other medical specialty, i.e. Physicians Assistant, Corpsman with unrestricted license in state.
* 3 years clinical practice experience.
* 2 years UM, Case Management, quality improvement and/or project management experience.
* Experience conducting presentations for member and/or provider training.
* Current New Mexico driver’s license.
* Ability to travel including overnight stays.
* Verbal and written communications skills.
* Data analysis experience.
* PC proficiency to include Word, Excel, and PowerPoint.




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