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Category: Nursing
Facility: FirstCarolinaCare
Department: FirstCarolinaCare
Schedule: Full Time - 36+ hrs/wk
Shift: Day Shift
Hours: 8a-5p
Job Details:

Assists in the assessment, development, planning and evaluation of  FCC’s Quality Management ProgramCollects data and supports all quality management initiatives including HEDIS, CAHPS, URAC, disease management programs and case management evaluation.Analyze data to identify trends with member population groups. Assist with analysis of HEDIS and CAHPS scores to identify opportunities for performance improvement.Assist with HEDIS medical record reviews. Develops programs and trains staff on quality initiatives. Completes audits on Utilization Review records. Participates in quarterly FirstQIC meetings.


Develop and conduct presentations on Quality Performance standards. Also supports and carries out responsibilities of the Health Services Department including, but not limited to: Utilization review through applying evidence-based criteria to selected covered services to determine medical necessity;Wellness program activities (work site health screenings, health education and coaching, wellness incentive plan administration);Chronic care management through identification and engagement of members diagnosed with or at risk for certain chronic diseases and their treating providers.


Graduate of an accredited R.N. program with a current, unrestricted North Carolina license or Compact State license.  Bachelor’s Degree in Nursing preferred but not required. At least five (5) years clinical nursing experience.3 – 5+ years of experience with quality management experience in a clinical or managed care setting required, including chart reviews, audits, surveys and reporting. Certified Case Manager designation preferred but not required. Basic Cardiac Life Support certification.Valid NC driver’s license.


 



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