Health Plan Quality RN - Aspire Health

Related keywords: remote job for nursesremote job in californiaremote job california

Job Overview

The Health Plan Quality RN position at Montage Health focuses on leading quality and performance improvement initiatives specifically geared towards CMS Medicare Star Ratings. This role plays a crucial part in enhancing the health plan's quality performance and ensuring regulatory compliance.

Key Responsibilities

The Health Plan Quality RN will lead various essential functions, including:

1. Clinical Management: Leading clinical strategic management regarding Star Ratings and other value-based performance strategies.

2. Regulatory Oversight: Providing oversight and analysis of all regulatory guidance and data related to Star Ratings, constantly monitoring performance and proactively identifying risks.

3. Education and Training: Facilitating education and understanding of performance measures among community partners, ensuring everyone is aware of significant impacts of improved ratings.

4. Activity Coordination: Coordinating activities throughout the organization to drive clinical improvements in areas such as provider engagement, data integrity, and member satisfaction.

5. Program Development: Developing, implementing, and monitoring the Stars Program and tactical work plans while ensuring alignment with the organization's broader mission and performance goals.

6. Performance Tracking: Tracking and reporting progress towards clinical quality goals across teams to ensure accountability.

7. Cross-Functional Collaboration: Identifying opportunities for collaboration to continually improve processes and outcomes beneficial for the organization and its members.

8. Clinical Assessments: Conducting clinical measure risk assessments and creating cross-functional plans to mitigate performance risks when necessary.

9. Vendor Management: When needed, managing external vendor relationships associated with value-based performance activities.

10. Competency Maintenance: Meeting ongoing competency requirements to maintain skills, knowledge, and abilities within the scope of the role.

Required Skills and Experience

To qualify for this role, candidates must meet specific experience and educational requirements:

• Minimum Required: RN license with at least 2 years of health plan experience in Quality, including exposure to HEDIS or Stars metrics. Prior MA plan experience is preferred. Additionally, applicants must have at least 3 years of clinical practice experience.

  

• Preferred Qualifications: Experience in project management within the healthcare industry and familiarity with health plan quality performance and ratings.

• Certifications/Licenses: A valid, unrestricted RN license from the state of California is required. Certifications such as CPHQ, CCM, or PMP are preferred but not mandatory.

Working Environment

This position is full-time and remote, making it an ideal opportunity for nurses who prefer a flexible work environment while still positively impacting healthcare quality.

Employer Overview

Aspire Health, a part of Montage Health, is a Medicare Advantage HMO that prides itself on community-centered services. They provide comprehensive medical coverage to seniors and other Medicare recipients in Monterey County. The network includes over 700 doctors and healthcare providers affiliated with hospitals in the region, emphasizing localized care and support for the community.

Compensation

The pay rate for this position is $64.91 per hour, reflecting the critical importance of quality roles within the health care system, especially concerning Medicare Star Ratings and overall health plan quality.

Summary for Job Seekers

For job seekers interested in the Health Plan Quality RN position, this role offers an excellent chance to lead and innovate in a meaningful area of healthcare. With a focus on quality, compliance, and member outcomes, this position aligns well with those who are passionate about improving healthcare delivery systems and driving performance-enhancing initiatives in collaborative environments.

Aspire Health’s commitment to quality improvement and care for the Monterey County community makes this position attractive not only from a professional standpoint but also on a personal level, knowing that your work contributes meaningfully to improving health outcomes for seniors and other Medicare beneficiaries.

This job offer was originally published on himalayas.app