Affinity Health Plan

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  • Quality Improvement Coordinator

     

    Affinity Health Plan is an independent, not-for-profit managed care company dedicated to serving the needs of low-income residents of the New York Metropolitan Area. Affinity serves over 260,000 enrollees through its Medicaid, Child Health Plus, Family Health Plus, and Medicare programs.

    The Quality Improvement Coordinator organizes and carries out efficient and effective quality of care investigations/reviews as well as ensures competent and responsive education of providers and staff.

    Essential Functions Include:

    • Conducts clinical complaint, quality indicator and risk management investigations at the site of care and identifies opportunities for improvement; coordinates interventions and tracks and monitors performance improvement plans.
    • Coordinates and conducts credentialing and recredentialing site and chart reviews for the provider network; submits summaries of findings and proposed performance improvement plans; follows up with providers as indicated.
    • Collaborates with health care providers in identifying opportunities and initiating strategies for improving performance, and provides them with formal and informal education for all aspects of quality management program activities, including complaints, credential, QARR, clinical QI studies, quality indicators, clinical guidelines, and prevention and treatment services.
    • Monitors provider records/procedures and other sources of data for compliance with medical record standards, preventive screening guidelines, access and availability standards, clinical pertinence criteria, clinical quality indicators and other guidelines consistent with quality management program activities; assists with coordination of the clinical review process for the QARR project.

     Requirements

    • BA/BS; Registered Nurse
    • 1-2 years clinical experience
    • Inservice/teaching and clinical research experience preferred
    • Minimum of one year quality improvement and/or utilization management experience in a managed care setting
    • Knowledge of NYSDOH/NCQA standards and regulations for quality and risk management

    If you meet or exceed these qualifications and are interested in this position, please respond by sending an email with your resume to desanchez@affinityplan.org with the position title in the subject line. You can also fax your resume to 718-794-7846, stating that you are applying for this position on the fax cover sheet. We are an Equal Opportunity/AA Employer. Only qualified applicants will receive a response. 

      

    No agency responses, please.