Quality Clinical RN Manager - Phoenix AZ - Evernorth Care Group

Purpose of Position: The Quality Clinical Manager is an execution-focused individual who supports Evernorth Care Group (ENCG) by working closely with the Chief of Quality and Nursing to drive successful analysis, design, execution, implementation, and recommendations for initiatives related to Clinical Quality and risk mitigation.

Work hours: Monday - Friday typically 8am - 5pm (Salary position)

Summary:

The Quality Clinical Manager utilizes innovative thinking about how to best assure the organization's quality improvement program and work plans are implemented and meet NCQA requirements and is a proactive collaborator that can take a high-level project or initiative vision and strategy, as well as input from key stakeholders, and design a detailed business proposal.

The Quality Clinical Manager is also detail oriented, exhibits excellent communication skills, and is able to easily adapt to changing circumstances.

The primary responsibility for the Quality Clinical Manager will be the oversight for the day-to-day operations of the Quality team, Policy and Procedure oversight, and Peer review assistance.

Clinical Responsibilities and Essential Functions


* Delivers expertise and leadership in the areas of Event management, Quality data and trend support, Provider peer review, and Policy and Procedure support.


* Provide oversight to Quality management for ENCG.


* In collaboration with the Chief of Quality and Nursing, support the overall ENCG Quality Management program inclusive of delegated functions, Peer Review process, Quality of Care and Adverse Event investigation and reporting, NCQA Recognition Programs, Patient Centered Medical Home quality standard implementation, state licensing quality program requirements and process improvement activities to ensure quality patient care provided in ENCG.


* Quality Clinical Manger will work with the Quality Advisor to identify and create project deliverables to ensure successful execution of projects and initiatives that align to the business strategy, desired capabilities, and corporate mission.


* Escalate risk and needs to ensure they are addressed considered in project selection/business requirement.


* Understand the clinical technology applications and processes at a high-level to best be able to document current and future state processes, as well as identify opportunities for process improvement to meet Quality metrics.


* Collect data, document processes, perform a preliminary analysis, and propose next steps.


* Facilitate meetings, document meeting minutes and action items, and provide follow ups as needed to ensure follow through on action items for projects and committees.


* Write and coordinate communications for projects and initiatives.


* Analyzing and appraising management as to performance of insurance products using measurement criteria; collecting and analyzing data, identifying variance and unacceptable performance, and monitoring...