Nurse Consultant, Quality Management

Description: • Ensures the delivery of evidence-based care and services for members according to HFS quality strategy and ABHIL population health model • Directs analysis and reporting of member and provider data to monitor interventions and effectiveness • Plans, conducts and evaluates targeted member/provider initiatives and supports development of HEDIS interventions and initiatives within the Quality Management Team • Reviews documentation and interprets data from clinical records or systems to apply appropriate clinical criteria and policies in line with HEDIS, regulatory, and accreditation requirements • Works closely with the Quality team, leadership and POSC to drive population-based improvements in care and outcomes Requirements: • 5 years experience in managed care, clinical, or health care related field • 1 year of project management experience • Registered Nurse (RN) license in the state of their residence • Bachelors Degree required Benefits: • Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan • No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching • Paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility Apply tot his job Apply To this Job