• Quality Improvement RN

    Job Locations US-NV-Las Vegas
    Posted Date 3 months ago(3 months ago)
    # 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 manage the day to day operations of the Culinary Health Fund Quality Program. This will include data collection, analysis and presentation to drive quality activities and broader population health initiatives. This position will assist as directed in quality meetings and teams and help prepare agenda items for required meetings.  The QI RN uses a comprehensive understanding of the care continuum across all healthcare settings to facilitate programs to measurably enhance the quality, process and cost effectiveness of delivered member care. The QI RN will be required to interface with a diverse range of clinical and administrative professionals, to resolve complex issues and to perform data analytic and reporting activities.


    To be successful, the candidate must be comfortable with publically available and utilized data measures/standards (HEDIS, NQF, MIPS, etc), data collection, data input, data analysis and report development. Will require experience with clinical chart review and analysis to support peer review, physician profiling. The QI RN will need to be comfortable meeting with network providers to review quality metrics, and facilitate collaborative approaches for implementation of evidence based guidelines and other clinical tools to reduce variation in clinical practice and to optimize clinical outcomes.




    • Analyze medical records, patient safety, quality and cost data sets and make recommendations based upon assembled data
    • Plan, organize and lead data collection and analysis activities
    • Monitors and analyzes outcomes to ensure goals, objectives, outcomes are met
    • Resolve simple and/or complex analytical problems
    • Present statistical and technical data in a clear and understandable manner utilizing appropriate visual aids
    • Effectively facilitate and coordinate the work of multidisciplinary groups engaged in quality improvement activities
    • Monitors provider quality complaints to identify trends and educational opportunities for improvement
    • Monitors quality improvement initiatives including, but not limited to, development and implementation of preventive health and chronic disease outcome improvement interventions such as member education and outreach interventions, provider education, member outreach interventions, medical record reviews, focus groups, and surveys
    • Clinical record (chart) review and investigation of all quality of care cases that are brought to the Quality Committee and collaborates with the Medical Director to determine impacts and next steps for actions.
    • 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.
    • 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




    Years of Experience and Knowledge

    • 3 ~ 5 years of related health care experience
    • 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. 
    • 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



    The information contained in this job description is designed to indicate the general nature and level of work performed in this job with a certain degree of specificity, where warranted.   In no instance, however, should the duties, functions, qualifications, or requirements be interpreted as all-inclusive. Management may, at its discretion, assign or reassign functions and duties to or from this job at any time, due to reasonable accommodation or other reasons.  Listed requirements, skills, qualifications and abilities included have been determined to illustrate the minimal standards required to successfully perform the position.


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