About the Job
PLEASE READ ALL APPLICATION INSTRUCTIONS BEFORE APPLYING.
**No corp-to-corp. Green Card holders, TN, and US Citizens only.
ONLY LICENSED REGISTERED NURSES WILL BE CONSIDERED FOR THIS POSITION.
RN - Team Lead
Please submit an updated resume (ideally, which includes a list of career highlights relevant to this specific position) to receive an additional submission form. Only applicants who provide both an updated resume and this submission form will be considered. This form must be completed and submitted no later than April 28th at 2:00 PM, but it is recommended that applicants apply as soon as possible.
The Quality Analyst/Trainer is responsible for providing clinical and educational support for the assigned areas. They are also responsible for the assessment of clinical decisions made by RN staff and non-clinical staff to ensure that decisions are based on appropriate and consistent application of policy and procedures/medical clinical criteria, nursing standards of practice, benefits and program guidelines. They are also involved in the analysis and coordination of the quality management program in order to obtain and maintain accreditation, and assist with group audits as necessary.
• Exceptional interpersonal and relationship skills
• Exceptional oral and written communication skills
• Proven problem identification and resolution ability.
• Basic concept and working knowledge of Case Management, Disease Management and other Care Management Programs.
• Registered Nurse with current Michigan License (required)
• Nursing Diploma or Associate’s Degree in Nursing (required)
• Bachelor’s Degree in nursing or other health related field (preferred)
• Three (3) to five (5) years of clinical experience in health related fields (required)
• Three (3) to five (5) years experience with BCBSM Care Management (preferred)
• Demonstrated clinical knowledge and experience relative to patient care and health delivery processes.
• Knowledge of care management principles
• Must have some leadership experience
• Other related skills and/or abilities may be required to perform this job
Principle Duties and Responsibilities
• Assist specific areas in deployment and operational activities and/or development, implementation and maintenance of clinical operational processes.
• Working with staff collaboratively to develop, modify, implement and maintain quality standards and/or data collection tools to include Vendor Management Programs.
• Troubleshoot problems, research quality issues, and submit recommendations. May be required to interface with other areas, both internal and external, to resolve problems.
• Assist personnel (both external and internal) by answering questions, supplying information, providing presentations, coaching, advising and training.
• Ability to identify and communicate program issues to the team leader in a timely manner and initiate problem resolution.
• Provide timely feedback regarding the result of all assessments to team leader and staff.
• Functions as a resource person for special areas as assigned.
• Provide analysis and coordination of existing quality system.
• Analyze trends and present reports to team leaders, managers, and committees.
• Complete evaluations with aggregated data and create and send reports to operational areas
• Identify or facilitate the identification of specific program, performance, and policy and procedure deficiencies and submit recommendations as necessary.
• Assist with group audit activities as necessary.
• Perform and lead focused audits as necessary.
• Provide quality overview presentation to new hires.
• Perform regulatory mock audits as appropriate for clinical and non-clinical staff.
• One on one employee consultation to address identified quality issues.
• Maintain minimum of 100% planned case reviews per month
• Conduct educational reviews of 2-5 cases/calls per month to assess the effectiveness of the formal training of the individual employee.
• Conduct Quality reviews on multiple programs.
• Participate in Division projects as assigned.
• Other duties may be assigned. These include, but are not limited to: