About the Company:
A Fortune 500 company, is a diversified, multi-national healthcare enterprise that provides a portfolio of services to government sponsored healthcare programs, focusing on underinsured and uninsured individuals. Many receive benefits provided under Medicaid, including the State Children's Health Insurance Program (CHIP), as well as Aged, Blind or Disabled (ABD), Foster Care and Long Term Care (LTC), in addition to other state-sponsored/hybrid programs, and Medicare (Special Needs Plans).
The Company operates local health plans and offers a range of health insurance solutions. It also contracts with other healthcare and commercial organizations to provide specialty services including behavioral health management, care management software, correctional healthcare services, dental benefits management, in-home health services, life and health management, managed vision, pharmacy benefits management, specialty pharmacy and telehealth services.
Analyze, develop, implement and monitor clinical quality improvement initiatives to achieve healthy outcomes.
- Perform duties and functions to comply with quality improvement programs according to state requirements.
- Support Quality Assurance Performance Improvement work plan/initiatives.
- Schedule and assist with committee and subcommittee preparation.
- Assist in investigation and resolution of member quality of care complaints.
- Audit medical records and monitor performance measures for health care risk management, sentinel events and trends.Audit medical record
- Bachelor’s degree in nursing preferred.
- 2+ years clinical, quality management or healthcare related experience.
- At least one year experience in quality function in a healthcare setting.
- LPN, LVN, RN, PA, or LCSW license preferred.
- Utilization management certification preferred.
- Certified Professional in Healthcare Quality preferred.
The company offers more than just medical insurance. They pay most of your benefits costs and in some cases – they pay 100 percent. Most of the benefits not covered by the company are paid with pre-tax payroll deductions.
- Health insurance
- Dental insurance
- Vision insurance
- Flexible spending accounts (includes health care, dependent care mass transit reimbursement)
- Short- and long-term disability insurance
- Basic Life insurance
- Supplemental AD&D
- Supplemental life insurance
- Wellness Program
- 401(k) retirement with company match
- Employee stock purchase plan
- Vacation, Personal and Sick time
- Paid Company Holidays
- Employee Assistance Program (EAP)
- Training and Learning Opportunities
- Tuition Reimbursement/Educational Assistance
- Service Awards
- On-site fitness center or discount at local fitness centers (most locations)
- Discounts for select local and national products and services, including cell phones, computers and more
- Other amenities may be available, but vary by location