Program Manager - Quality Audit Nursing Education (RN)

Southwestern Health Resources and Care N' Care Insurance Company are looking for top skilled Program Manager - Quality Audit RN. Is that you?

Work location: Southwestern Health Resources/Care N' Care Insurance Company Headquarters, 1601/1603 Lyndon B. Johnson Freeway, Farmers Branch, TX 75234.

Work environment: Starts/Quality Department.

Please note: The Program Manager - Quality Audit Nursing Education (RN) will be an employee of Southwestern Health Resources (SWHR) working primarily supporting Starts/Quality activities for Care N' Care Insurance Company. SWHR is a clinically integrated network formed by Texas Health Resources (THR) and University of Texas Southwestern Medical Center (UTSW). Care N' Care is a regional Medicare Advantage health plan.

Work hours:

• Full-time, 40 hours per week.

• Monday - Friday, Day shift.

• This is a Hybrid position, requiring onsite workdays (1-3 days/week) based on department business needs.

• In-person attendance required at department meetings, provider and staff trainings and/or other department authorized activities, at the above-mentioned address or other locations as directed by the department management (example - provider office address).

Organization Highlights

Southwestern Health Resources (SWHR) is a patient-centered, clinically integrated network of 29 hospital locations and more than 6,900 physicians and clinicians caring for more than 730,000 patients across 16 counties in North Texas. Blending the strengths of Texas Health Resources and the University of Texas Southwestern Medical Center, SWHR offers an unmatched ability to connect individuals with a full spectrum of nationally preeminent, clinical care. SWHR is the parent of Care N' Care Insurance Co., a leading regional Medicare Advantage health plan providing care to approximately 10,000 members.

At SWHR, we believe healthcare can be more integrated, accessible and affordable for all. Our purpose: to build a better way to care, together. Our promise: to simplify and empower care, for good.

EducationBachelor's Degree Nursing Req
Master's Degree Business, Public Health or Nursing PrefExperience5 Years Healthcare experience to include Hospital or Outpatient Care Setting, including 2 years in healthcare chart abstractions, project management preferably related to HEDIS, CMS or other accreditation surveys. ReqLicenses and CertificationsRN - Registered Nurse Active RN license Upon Hire ReqSkills Ability to read and interpret all types of medical records, including physician documentation.
Independent problem identification/resolution, critical thinking and decision-making skills
Must be able to prioritize, plan, and handle multiple tasks/demands simultaneously.
Possess planning, organizing, conflict resolution, negotiating, collaborative and interpersonal skills.
Ability to work collaboratively in a team-oriented environment with a strong customer-service orientation
Strong written and verbal communication skills; strong analytical, organizational and time management skills required
Proficiency in Microsoft Office Word, Excel and Access.
Work requires demonstrated ability and skills with project management and quality improvement tools, such as Microsoft Project, Visio, Excel, SharePoint, or Qeystone.
Expert level knowledge of NCQA, HEDIS, Medicaid and Medicare is required.
Ability to manage multiple, complex projects with strict HEDIS deadlines.
Strong knowledge of health care related coding and/or STAR ratings is a plus.
Thorough understanding of statistics, data analytics, modeling, reporting methods and data mining methodologies.SupervisionIndividual ContributorADA RequirementsExtreme Heat 1-33%
Extreme Cold 1-33%
Extreme Swings in Temperature 1-33%
Extreme Noise 1-33%
Working Outdoors 1-33%
Working Indoors 67% or more
Mechanical Hazards 1-33%
Electrical Hazards 1-33%
Explosive Hazards 1-33%
Fume/Odor Hazards 1-33%
Dust/Mites Hazards 1-33%
Chemical Hazards 1-33%
Toxic Waste Hazards 1-33%
Radiation Hazards 1-33%
Wet Hazards 1-33%
Heights 1-33%
Other Conditions 1-33%Physical DemandsSedentaryTravel RequirementsLocal 30% Travel to providers/practices/clinics for education