Quality Specialist Nurse Job at MMM Holdings
LE0002 MMM Holdings, LLC
It's fun to work in a company where people truly BELIEVE in what they're doing!
We're committed to bringing passion and customer focus to the business.
POSITION DESCRIPTION
The Quality Specialist Nurse is responsible for monitoring quality of care and services delivered to Members including provider site visits and medical record reviews.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Collaborates in the implementation of educational activities geared at improving quality measures. Coordinates quality assessment activities related to clinical areas in conjunction with the Quality Director in all service areas. Performs provider site visits in all MMMHC/PMC service areas and medical record reviews in accordance with the policies and procedures. Performs medical record review in physician’s offices of selected HEDIS sample. Performs follow audit to those providers with a score below 80% in either medical record documentation or physician office standards. Documents findings of audits into the Physician Audit application electronic system. Performs onsite visits to providers for investigation of quality of care issues and documents findings in the forms develop for that purpose. Prepares letters of findings to be sent to provider and discuss with Medical Director for signature. Maintains a log of visits and findings by provider. Performs activities in compliance with MMM Healthcare/PMC and CMS requirements. Prepares and submits to the Quality Director a monthly report of activities performed. Performs other duties relevant to the position.
EDUCATION AND EXPERIENCE
Bachelor’s Degree of Science of Nursing from an accredited school of nursing. Current unrestricted Generalist Nursing license to practice in Puerto Rico. Minimum of three years of experience in clinical nursing. Previous QA review experience preferred.
GENERAL SKILLS AND KNOWLEDGE
- Must have ability to work as a team player with excellent communication skills.
- Must solve resource issue in a creative, positive manner.
- Must possess the ability to make independent decisions when circumstances warrant such action.
- Must have knowledge of local community resources
- Computer literate in Microsoft Windows applications, software and Internet
LANGUAGE SKILLS
Ability to speak, read and write in English and Spanish, preferable Bilingual in English to Spanish. Ability to read, analyze, and interpret general business periodicals, operating and maintenance instructions, procedure manuals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.
MATHEMATICAL SKILLS
Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume. Ability to apply concepts of basic algebra and geometry. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.
REASONING ABILITY
Define problems, collect data, establish facts, and draw valid conclusions. Interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables
INTERPERSONAL RELATIONS
Internal Contacts
- Staff employees
- Management at all levels of the organization
External Contacts
- External Providers
- External Clients
- Vendors
- Government and Federal Agencies
PHYSICAL AND MENTAL DEMANDS
Requires sitting and standing associated with a normal office environment; mobility to complete hospital rounds and other errands. Regularly talks and hears. This position requires that weight be lifted or force be exerted up to 10 pounds.
ENVIRONMENTAL AND WORKING CONDITIONS
Normal busy office environment (examples: business office with computers and printers, light traffic). The noise is typically moderate. Travel around different locations required. General exposure to weather conditions while traveling. Valid driver’s license required. A flexible schedule which could involve evening, holiday and weekend work.
If you like wild growth and working with happy, enthusiastic over-achievers, you'll enjoy your career with us!
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