Wellness Quality Assurance Nurse Manager

Overview

• Lead quality assurance initiatives in a hybrid environment, ensuring compliance with HEDIS specifications and enhancing healthcare outcomes.
• Supervise clinical activities of Wellness RNs and Health Educators, promoting healthier lifestyle behaviors among members.
• Collaborate with providers to address gaps in care for chronic conditions and mental health concerns.
• Engage in data analysis, trend identification, and quality improvement recommendations to enhance healthcare services.
• Participate in health fairs, screenings, and outreach events to promote community health.
• Provide clinical oversight and supervision for quality assurance projects and member outreach initiatives.
• Educate members on acute and chronic conditions, fostering informed healthcare decisions.
• Contribute to seasonal vaccination campaigns and other health testing programs as required.

Key Responsibilities & Duties

• Coordinate development of goals and outcomes using HEDIS specifications for quality improvement and corrective action plans.
• Review charts and population-based data for quality improvement processes and HEDIS compliance.
• Track and analyze quality-related issues, identifying trends and recommending enhancements.
• Serve as a clinical liaison between the client and providers on quality-of-care concerns.
• Monitor care gaps for chronic conditions and mental health, addressing issues with providers.
• Supervise and oversee activities of Wellness RNs and Health Educators in quality assurance projects.
• Educate members on health conditions and promote healthier lifestyle behaviors.
• Participate in community health initiatives, including health fairs and outreach events.

Job Requirements

• Valid New York State Registered Nurse (RN) license required; Bachelor’s degree in Nursing preferred.
• Minimum three years of quality improvement experience and two years of management experience.
• Strong clinical assessment, patient education, and motivational interviewing skills.
• Knowledge of HEDIS specifications and NCQA standards preferred.
• Intermediate computer literacy and proficiency in Microsoft Outlook, Word, and Excel preferred.
• Bilingual in Spanish and valid NYS driver’s license preferred.
• Ability to work flexible hours, including evenings and weekends as needed.