Quality Assurance/Performance Improvement RN

US-NY-New York
4 months ago(9/11/2017 3:34 PM)
Job ID
# Positions
ArchCare Senior Life- Harlem
Experience (Years)
Work Days Per Week
Shift Start Time
8:30 AM
Shift End Time
5:00 PM
# Hours


Performance Management

Responsible for ensuring the quality of the member experience and protecting the integrity of the grievance and appeals system of ASL.




Manages all the grievance and appeals received by ASL.
Facilitates the disposition of all of the grievance and appeals.
Analyzes grievance and appeals data and prepares statistical and administrative reports related to the grievance and appeals.
Implements the policies and procedures related to the handling of the grievance and appeals.
Assists in preparing requisite reports to the regulatory bodies as prescribed.
Interacts with members, caregivers, vendors, contracted providers and employees within the department to investigate grievance and appeals.
Conducts periodic audit of systems and processes that impact on member experience.
Promote member and caregiver satisfaction.
Leads Level II Incident report and follow up according to regulatory guidelines.
Utilizes data to support operational performance improvement initiatives.
Assists with quality improvement initiatives that seek to improve member experience with ASL.
Monitors regulatory updates related to quality standards (e.g. grievance and appeals, Level II, etc.).
Problem-solves with the IDT team to promote member satisfaction, retention efforts.
Makes recommendation for improvement of processes that affect member experience.
Encourages accountability among vendors and delegated entities to mitigate the incidence of grievance and appeals.
Conducts root-cause analysis related to trends observed from grievance and appeals, Level II, satisfaction surveys, risk indicator reports and if necessary makes recommendations to alleviate the risk for liability, disenrollment and dissatisfaction among the members.
Performs other and related tasks as assigned.


Education & Experience
Formal Education: Bachelor's Degree
Experience: 3 years
License, Registration, and / or Certification Requirement: Yes
Minimum Knowledge: Requires advanced knowledge of a specialized or technical field or a thorough knowledge of the practices and techniques of a professional field.
Language Ability: Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of the organization.


Education Requirements
Bachelors degree required or equivalent professional experience in managing health care needs for seniors.


Experience Requirements
3 years of related job experience.


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