RN Clinical Operations Quality Assurance Improvement Case Management Job Listing at MedStar Health in Columbia, MD (Job ID 172852)

Description

About the Job

General Summary of Position
The Clinical Operations Quality Assurance and Improvement RN leads the design implementation and continuous advancement of quality training auditing compliance and performance improvement programs across Clinical Operations for MedStar Family Choice DC and Maryland. This role serves as the clinical subject matter expert for documentation integrity NCQA standards utilization management case management regulatory compliance and operational best practices.In partnership with the Vice President of Clinical Operations and department leaders the incumbent develops and implements standardized processes training programs competency validation frameworks and quality monitoring activities that promote consistent clinical practice regulatory adherence and operational excellence. Through ongoing audits data analysis performance monitoring and targeted improvement initiatives this role identifies opportunities to enhance documentation quality workforce competency process effectiveness member outcomes and organizational performance.The Clinical Operations Quality Assurance and Improvement RN plays a critical role in accreditation readiness regulatory audits system implementations and enterprise-wide clinical improvement initiatives while fostering a culture of accountability continuous learning quality and excellence.

Primary Duties and Responsibilities

• Bachelor's degree in Nursing required
• Master's degree Healthcare or Nursing preferred

• 3-4 years Case Management and utilization review experience required and
• 3-4 years Clinical training auditing quality improvement staff development and/or regulatory compliance experience. required and
• 1-2 years Experience in NCQA accreditation managed care organization / health plan. preferred

• RN - Registered Nurse - State Licensure and/or Compact State Licensure Valid RN license in the District of Columbia and Maryland Upon Hire required and
• CCM - Certified Case Manager Active certification in good standing within 2 years preferred

• Skilled in planning executing and evaluating educational gaps and developing performance improvement initiatives
• Possess exceptional interpersonal and communication skills
• Knowledge of current trends in healthcare delivery and Case Management / utilization review criteria
• Ability to use computer to enter and retrieve data.
• Ability to create edit and analyze (Word Excel and PowerPoint)
• Demonstrate proficiency with all MedStar Family Choice software systems that support the clinical operation.
• Possess exceptional interpersonal and communication skills.