Blue Cross of Idaho Clinical Quality Outreach Spec RN in Meridian, Idaho
Quality Outreach Specialist works collaboratively with Medical Affairs, Provider Services and other departments to execute the internal initiatives needed to operationalize and The Clinical Quality Outreach Specialist works with the provider networks and other groups that are involved in valued based contracting at Blue Cross of Idaho. This position oversees the process for improving quality/performance metrics applicable to the value based contracting process. This position will facilitate plan/provider integrated meeting structure designed to facilitate joint problem solving and the development of processes and initiatives that will improve the functioning of the provider network and group in achieving improved quality/performance. This Clinical Quality Outreach Specialist works collaboratively with Medical Affairs, Provider Services and other departments to execute the internal initiatives needed to operationalize and support the processes that execute new valued based quality /performance measures and improve the performance of the provider networks and group.the processes that execute new valued based quality /performance measures and improve the performance of the provider networks and group.
Five years’ in one of the following; continuous quality improvement, (CQI) practice management, medical management, health care analytics, nurse informatics, managed care principles and practices, PCMH or ACO programs for quality improvement initiatives.
Experience in implementation of work plans, leading initiatives, and collaborating successfully with a team and leadership
Experience preparing and presenting information to clinical and executive leadership
- Bachelor’s Degree
- Registered Nurse
Health Plan or Managed Care
Clinical quality outcome metrics including but not limited to HEDIS and NQF measures, clinical quality hospital measures, and patient safety.
Knowledge and understanding of performance and clinical reporting, utilizing HIT, EMR, disease registries and other technology
Electronic Health Records in outpatient settings
Database entry and management
Continuous Quality Improvement
Federal and state regulatory agencies such as Centers for Medicare and Medicaid Services (CMS) and Medicaid specific to payment innovation, MACRA, MIPS
Patient Centered Medical Home and associated accrediting agencies
Demonstrated experience implementing Clinical Practice Transformation related to quality
Position reports to: Director of Care and Quality Management Salary Grade: 17 Internal Job Posting: 3/13/2018-3/20/2018 External Job Posting: 3/13/2018-until filled
Job ID #: 1735
Location: Meridian, ID (Corporate Headquarters)
Job Category: Nursing
Education Required: Bachelors Degree
Employment Type: Full Time
Experience Required: 5 - 7 Years
Relocation Provided: No