• Quality Improvement & Network Auditor

    Job Locations US-NV-Las Vegas
    Posted Date 1 month ago(4/26/2018 5:59 PM)
    # of Openings
    Healthcare Delivery
    Culinary Health Fund
  • Overview

    CHF logo with A division of UHH



    Our mission-driven organization is focused on the “Triple Aim” - Better Health, Better Healthcare and Lower Costs to individuals and their families who participate in our health plans.


    The Culinary Health Fund serves over 100,000+ workers and 220,000 covered lives in the hospitality and gaming industry. Our desire to be innovative and progressive drives us to develop impactful programs and benefits designed to engage our participants in managing their own health and healthcare. Our vision is exciting and challenging. Please read on to learn more about this great opportunity!



    Key Attributes:


    • Integrity – Must be trustworthy and principled when faced with complex situations

    • Ability to build positive work relationships – Mutual trust and respect will be essential to the collaborative relationships required

    • Communication – Ability to generate concise, compelling, objective and data-driven reports

    • Teamwork – Working well with others is required in the Fund’s collaborative environment

    • Diversity – Must be capable of working in a culturally diverse environment

    • Continuous Learning – Must be open to learning and skill development.  As the Fund’s needs evolve, must be proactive about developing new areas of expertise

    • Lives our values – Must be a role model for the Fund’s BETTER Culture and Mission (Better, Engage, Teamwork, Trust, Empower, Respect)



    A purpose of this position is to analyze medical charts, trend lines, and applicable transparency websites, to determine whether there are adverse trends and peer review cases comply with standards. Build quality standards into Network panel. To ensure negotiated hospital contracts contain measureable, consistent, contemporary quality measurement language. Provide site visits of new providers and providers for whom the Fund has received complaints. 




    • Review data, create information from which positive or negative trends may be identified
    • Collect and analyze patient safety, quality and cost data sets
    • Make recommendations based upon assembled data
    • Demonstrate ability to apply statistical principles and techniques
    • Demonstrate ability to apply nursing clinical principles and practices; follow Medical Staff guidelines and apply to Performance Improvement/Utilization Management practices
    • Demonstrate ability to interpret regulatory changes, federal regulations, and apply value based patient and provider care measurements
    • Maintain and improve knowledge and skills (including continuing education required by the profession and regulatory agencies to perform job functions
    • Knowledge and skills related to the Organization’s mission, vision, values, goals and policies and procedures
    • Demonstrate ability to effectively communicate information, issues and concerns to Medical Director and health care team members (including supervisors) as appropriate including oral and written communication
    • Demonstrate ability to communicate effectively with a wide variety of diverse individuals inclusive of Physicians and hospital leadership(s) under normal and/or stressful circumstances
    • Conduct periodic provider visits with Healthcare Services Manager and/or Clinical Pharmacist to discuss drug prescribing and/or office practices.
    • Work cooperatively with co-workers
    • Demonstrate an ability to prioritize and perform multiple tasks
    • Meet deadlines for assigned projects. Complete work assignments in a timely and dependable manner, meeting established deadlines
    • Demonstrate accuracy and thoroughness in performing work assignments
    • Demonstrate flexibility with work schedule changes; adjust to the staffing needs of the Organization
    • Performs other duties as assigned within the scope of responsibilities and requirements of the job

    Performs Essential Job Functions and Duties with or without reasonable accommodation


    Skills and Abilities

    • Intermediate level Microsoft Office skills (PowerPoint, Word, Outlook)
    • Interpret patient charts and/or episodes of care and/or clinical practice outcomes to determine whether care given was appropriate and properly documented
    • Analyze statistical and other quantitative data
    • Establish interpersonal relationships to interact effectively with co-workers, supervisor, staff in other work units and exchange or convey information
    • Interact with Physicians and Payors relative to patient care value
    • Manage competing deadlines and multiple projects in a fast-paced environment
    • Perform the essential functions of this job with or without reasonable accommodation





    Years of Experience and Knowledge

    • 3 ~ 5 years of related experience minimum
    • Working knowledge and experience in a quality improvement environment
    • Knowledge of Joint Commission, State statutes governing hospital services and health care
    • Knowledge of Medicare/Medicaid guidelines and other relevant regulations and standards
    • Knowledge of clinical medical and nursing procedures, disease processes, patient safety practices and principles, and infection control practices 

    Education, Licenses, and Certifications

    • High School Diploma or equivalent experience in quality improvement environment
    • Required: Valid license by the State of Nevada to practice as a Registered Nurse
    • Preferred: Membership in one or more of the following boards: National Quality Assurance Professionals (NQAP) – or – American Board of Quality Assurance and Utilization Review Physicians (ABQAURP) – or - InterQual.


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