Senior Quality Improvement Nurse (RN) - Facility Site Review

We have an opportunity to join the Alliance as a Senior Quality Improvement Nurse (RN) - Facility Site Review in the Quality Improvement and Population Health Department. 

WHAT YOU'LL BE RESPONSIBLE FOR

 

Reporting to the Clinical Safety Supervisor, this position:

• Develops, manages, and measures a comprehensive healthcare strategy in alignment with Department of Health Care Services (DHCS) standards of care and in collaboration with internal stakeholders and network providers to promote evidence-based practices and improve member health outcomes
• Collaborates with the Quality Improvement and Population Health Department Team and other departments to evaluate and report observed and/or measured trends in individual and group provider performance
• Participates in local, regional, and state audits and initiatives to measure, analyze and improve member health outcomes
• Evaluates patient safety and quality issues and communicates findings to internal stakeholders, network providers, and community partners
• Trains and mentors Quality Improvement Nurses-Facility Site Review

ABOUT THE TEAM

Our goal is to ensure a safe and competent provider network by conducting three key types of site reviews for Primary Care Providers (PCPs): Physical Accessibility Reviews, Facility Site Reviews, and Medical Record Reviews. Through these reviews, we assess compliance with clinical, administrative, and environmental standards. We work collaboratively with providers to identify and resolve issues that impact the quality of care, supporting continuous improvement in clinical safety and service delivery.

THE IDEAL CANDIDATE 

 

• Highly organized and detail-oriented registered nurse with strong clinical judgment and a proven track record of promoting quality and patient safety in diverse healthcare settings
• In-depth knowledge of clinical protocols, documentation standards, and regulatory requirements related to medical record review and patient safety
• Experienced in leading and supporting performance improvement initiatives aligned with state and federal healthcare regulations
• Skilled communicator with the ability to collaborate effectively across all levels of healthcare organizations, from front-line staff to executive leadership
• Demonstrated ability to work independently in the field with professionalism, accountability, and excellent time management
• Certified Site Reviewer and Certified Master Trainer as defined by DHCS, with ongoing certification maintenance and training experience is a requirement for this role

 

WHAT YOU'LL NEED TO BE SUCCESSFUL

 

To read the full position description, and list of requirements click here. 

• Knowledge of:
• Principles and practices of clinical nursing
• Managed care, the Medi-Cal program, and related policy
• Medical practice operations and healthcare delivery systems
• Principles and practices of healthcare quality improvement
• Proficiency with Windows based PC systems and Microsoft Word, Excel, PowerPoint, and Outlook
• Methods and techniques of research, analysis, and reporting
• Ability to:
  • Evaluate medical records and other health care data
  • Conduct and coordinate audits, analyze audit results, and make recommendations for action
  • Identify issues, conduct research, gather and analyze information and data, reach logical and sound conclusions, and make recommendations for action
  • Synthesize large amounts of data and develop actionable plans to address provider issues and respond to audits
  • Interpret, apply, and explain policies, regulations, terms, and procedures
  • Act as a FSR subject matter expert and provide guidance regarding the more complex FSR activities
• Education and Experience:
  • Current, unrestricted license as a Registered Nurse issued by the State of California
  • Current certification as a Certified Site Reviewer as defined by DHCS
  • Possession and continued maintenance of Certified Master Trainer certification issued by DHCS within one year of hire
  • Bachelor’s degree and a minimum of five years of experience as a Registered Nurse which included a minimum of three years of acute care or primary care experience with an emphasis on preventative care and a minimum of two years of experience in Quality Improvement (a Master’s degree may substitute for two years of the required experience); or an equivalent combinat