Quality Improvement Spec Job
Coventry Health Care - St. Louis, MO

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Job Title: Quality Improvement Spec

Posting Location: MO - St. Louis (Maryville Centre)

Location: MO - St. Louis (Maryville Centre)

Employment Status: On Call

Job Requisition Number: 167254

External Description:
Quality Improvement Coordinator

GENERAL SUMMARY

Responsible for the research and identification of quality of care issues to
ensure compliance with Coventry's quality improvement programs as well as
accreditation and regulatory standards.

ESSENTIAL RESPONSIBILITIES

  • Maintains accurate documentation of all quality improvement activities, i.e.,
studies, surveys, audits, peer reviews, etc. Performs analysis and provides
oversight for delegated functions. Prepares weekly and monthly reports as
required.
  • Performs quality improvement studies as they relate to trends identified via
utilization review activities, utilization patterns, audits, HEDIS results,
appeals, etc.
  • Identifies possible quality of care issues through research and data analysis.
Prepares and distributes accurate and timely reports according to department,
documentation standards, and regulatory requirements.
  • Under the direction of assigned Medical Directors and quality improvement
management, conducts audits to research quality of care issues .
  • Assists in conducting peer review chart audits, compiling statistics, and
reporting results to the peer review and quality improvement committees of the
assigned plan.
  • Monitors and assures that follow-up re-evaluation activities take place when
deficiencies are identified and recommendations for corrective action have been
made.
  • Provides education to members and employer groups regarding preventive health
and wellness.
  • May complete an annual review of department policies and procedures and make
recommendations for updates based on changing needs or trends.
  • Assists in preparing the annual program evaluation and work plan.
  • Performs other duties as required.
JOB SPECIFICATIONS

  • Licensed Practical Nurse (LPN) or Registered Nurse (RN) with active state
license required.
  • Complies with all state certification requirements in the state where job
duties are performed.
  • Previous (2-4 years) clinical experience required.
  • Bachelor's degree preferred.
  • Previous quality improvement and/or managed health care experience preferred.
  • Fundamental knowledge of relevant legal, medical, and regulatory terms,
issues, and practices.
  • Good communication, organizational, analytical and computer skills.
  • Valid driver's license.
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we
are committed to building a talented and diverse team.

Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we
are committed to building a talented and diverse team.

Coventry Health Care - 2 years ago - save job - copy to clipboard
About this company
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In May of 2013, Coventry became a part of Aetna. We are excited to join together with common values and a common mission: empowering people...