RN – Quality Assurance and Performance Improvement

Job Description

Elderwood IPA is seeking a Quality Assurance and Performance Improvement (QAPI-RN) to join our incredible growing team of professionals in Buffalo, NY!

Why should you join Elderwood IPA?
Monday-Friday Schedule w/ no weekends or overnights
Remote working options
Medical, Dental & Vision upon 1st of month following 60 days of hire
Up to 140 hours (19 days) of PTO time PLUS six (6) holidays within the 1st year
401(k) retirement plan with vested employer match up to 4%
Substantial Referral program

Responsibilities:

Supports quality assurance and performance improvement activities including, but not limited to, analyzing clinical data to identify trends and opportunities, recommending improvements, and serving as a subject matter expert for the organization.
Develop and implement strategies to increase member participation in preventive services such as mammograms, dental exams, hearing exams, eye exams, and vaccinations.
Identify members who are non-compliant with NYS quality indicators and prioritize them for targeted interventions.
Develop and implement strategies to engage non-compliant members and address barriers to compliance.
Develop and implement outreach campaigns for members that are due for preventive services and screenings.
Conduct regular audits to reassess compliance with NYS quality standards and regulations.
Prepare and present regular reports on quality, population health, and utilization management metrics.
Serve as a liaison between members and the broader medical neighborhood, including primary care providers, specialists, and community-based organizations (CBOs).
Work with clinical teams to ensure timely and effective follow-up on missed preventive services and screenings.
Provide ongoing support and education to members to promote self-management and adherence to care plans.
Audit previous UAS-assessments to ensure Quality Gaps in Care are addressed.
Track and document outcomes of face-to-face visits to measure the impact on quality indicators.
Conduct internal utilization audits and risk analysis.
Reviews requests for medical necessity
Assist in reviewing member conditions and risk scores to ensure services in place are appropriate.
Develops processes, policies, and workflows necessary to meet business goals.
Analyzes department productivity and identifies areas for improvement.
Monitor and review on-going tracking systems to ensure services are in place.
Review member medical records and ensure duplication of services is not occurring.
Other duties as assigned.

Qualifications:

Must be able to perform data analysis, report on outcomes, and provide updates routinely relative to clinical activities and risk scores
Strong analytical thinking, independent decision-making and problem-solving abilities
Exceptional communication skills both verbal and written
Displays team-focused demeanor and attitude
Is self-directed, demonstrates initiative and accountability
Strong organizational skills
Excellent interpersonal and presentation skills, both one-on-one and in group settings
Ability to perform in a fast-paced environment, prioritize and multi-task
Ability to handle sensitive, confidential information and maintain privacy
Must possess proficient computer skills, including working knowledge of Microsoft Office Suite, e-mail systems, electronic medical records, and web-based programs.

HIPAA Privacy

This position description is not intended to imply a contract of employment. Employment with Elderwood IPA (EIPA) is “at-will”. Employment at-will may be terminated at any time by the employee or EIPA. All requirements and duties are considered essential functions. EIPA also reserves the right to adjust workers’ schedules and physical locations based on operational needs.

EOE Statement:

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved