The Clinical Quality Coordinator performs provider site visit audits which include environmental and medical record reviews as part of the credentialing/re credentialing process and suspected/potential quality of care issues. Provides a written report of the outcome/findings and collaborates with Quality/Accreditation, Credentialing and Provider Operations to disseminate the results to the provider and implement the necessary steps based upon those results per HSCSN policy. Develops, monitors, measures and evaluates quality improvement (QI) and process improvement (PI) initiatives per Quality and Performance Improvement Program.
Minimum Experience Requirements: Three (3) to five (5) years of experience in developing, implementing, and evaluating clinical QI/PI initiatives in a MCO environment. Three (3) to five (5) years of professional clinical experience. Ability to work under pressure, strong organizational and analytical skills is required. Demonstrated project management skills with the ability to handle multiple concurrent projects. Ability to work effectively with providers and multidisciplinary teams across departmental lines. Previous regulatory compliance, NCQA/URAC accreditation/certification experience and HEDIS reporting are desired. Excellent written and verbal communication skills. Knowledge of basic computer applications MS Suite (Word, Excel, PowerPoint, Outlook).
Minimum Education Requirements: Associate or Bachelor’s degree in nursing is required, Bachelors is preferred as well as a Master’s degree in MSN, MPA, or MPH. CPHQ preferred (Must be obtained within 18 months of employment).
Minimum Licensure Requirements: Active RN License in the District of Columbia. CPHQ preferred (Must be obtained within 18 months of employment).
Washington, DC residents are strongly encouraged to apply.
About Health Services for Children with Special Needs, Inc.
Health Services for Children with Special Needs, Inc. (HSCSN) is a dedicated District of Columbia Medicaid health plan that coordinates health, social, and education services for the pediatric Supplemental Security Income (SSI) and SSI-eligible populations of Washington, DC.
Exclusively focused on children and young adults with special health care needs up to age 26, our plan is impressively c...omprehensive. Our dedicated, caring staff of health care professionals is genuinely committed to helping our members and their families reach their full potential.