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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in Quality Management policies and regulatory compliance, with a strong focus on conducting audits, monitoring corrective action plans, and performing HEDIS data abstractions. Possesses a solid foundation in nursing principles and evidence-based practices, complemented by effective communication and organizational skills.
Highest-signal resume keywords
Quality ManagementCertified Site ReviewerRegistered Nurse (RN) LicenseHEDIS Data AbstractionRegulatory Compliance
About the role
Key responsibilities & impact- Implement Quality Management policies, procedures, and activities under the direction of the Manager, Quality Management Nurses
- Enforce DHCS regulatory requirements pertaining to Facility Site Review (FSR) and Medical Record Review (MRR) criteria
- Perform initial, periodic, and verification Site Review and Medical Record Surveys for assigned Primary Care Providers
- Conduct other regulatory audits as assigned
- Review Primary Care Provider Corrective Action Plans (CAP) submissions and monitor CAP compliance
- Perform focused audits as directed by IEHP Subcommittees
- Perform annual HEDIS data abstractions
- Monitor assigned PCPs for potential problem hours and document findings
- Review QM reports and CAP log weekly; ensure provider compliance and follow up
- Attend and participate in Quality Management Committee and/or Subcommittee meetings
- Attend Site Review and Medical Record Survey training as mandated by DHCS to maintain and become a Certified Site Reviewer
- Attend Quality Management, Medical Services, and other inter-departmental staff meetings
- Perform other duties required to ensure successful Plan operations
Requirements
What you’ll need- Three (3) or more years of any individual or combined experience in Quality Assurance, Utilization Management, Case Management, provider liaison duties, and/or clinical experience in a hospital/clinical setting
- Experience preferably in an HMO or Managed Care setting
- Associate’s degree in Nursing from an accredited institution required
- Possession of valid Certified Site Reviewer Certificate issued from DHCS or participating Medi-Cal Managed Health Plan Provider
- If not a CSR, the candidate should be willing and able to get certified within 6 months of hire
- Possession of an Active, unrestricted, and unencumbered Registered Nurse (RN) license issued by the California BRN required
- Valid State of California driver's license and valid automobile insurance
- Knowledgeable and understanding of nursing principles & evidence based practices
- Computer applications: spreadsheet, database, and word processing
- Strong organizational, time-management, and critical thinking skills
- Excellent written and verbal communication and interpersonal skills
- Highly skilled in interpersonal communication, including conflict resolution
- Minimal to moderate physical activity; may include standing, bending, sitting for long periods of time and repetitive motion
- Ability to manage multiple projects with completing deadlines and changing priorities
- Automobile travel within the Inland Empire
- May periodically be required to report to IEHP’s main campus for in-person meetings or for other business needs as determined by IEHP leadership
Benefits
Comp & perks- Competitive salary
- State of the art fitness center on-site
- Medical Insurance with Dental and Vision
- Life, short-term, and long-term disability options
- Career advancement opportunities and professional development
- Wellness programs that promote a healthy work-life balance
- Flexible Spending Account – Health Care/Childcare
- CalPERS retirement
- 457(b) option with a contribution match
- Paid life insurance for employees
- Pet care insurance
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Quality AssuranceUtilization ManagementCase ManagementSite ReviewMedical Record ReviewData AbstractionAudit PerformanceCorrective Action PlansNursing PrinciplesEvidence-Based Practices
Soft Skills
Organizational SkillsTime ManagementCritical ThinkingWritten CommunicationInterpersonal Communication
Tools & Technologies
Spreadsheet ApplicationsDatabase ApplicationsWord Processing Applications
Certifications & Qualifications
Certified Site Reviewer CertificateAssociate’s Degree in Nursing
Industry Keywords
Managed CareHMOFacility Site ReviewMedical Record ReviewCalifornia BRN