ABOUT US: Central California Alliance for Health (the Alliance) is an award-winning regional non-profit Medi-Cal health plan. The Alliance began operating in 1996 and uses the State’s County Organized Health System (COHS) model of Medi-Cal managed care. Our vision is to be a recognized leader in creating local health care solution.
We currently serve over 350,000 members in three counties (Santa Cruz, Monterey and Merced) in Central California. We are a group of over 500 dedicated individuals driven by our mission of providing accessible, quality health care that is guided by local innovation. We are value-based, guided by the following:
• Culture: We strive for a respectful, diverse, professional and fun workplace. • Customer Service: Our customers’ satisfaction is our highest priority. • Excellence: We value and continuously improve quality in our services. • Innovation: We leverage local talent to create solutions. • Integrity: We tell the truth and do what we say we will do. • Partnership: We collaborate with others for strong solutions. • Stewardship: We manage responsibly, and earn the trust of partners and regulators.
We approach health care with innovative methods, and include care management of high utilizers, and social determinants of health in our strategic planning. We strive to develop a regional health care system that delivers quality, high value health care, and we engage actively with our community partners, agencies and stakeholders to share this responsibility.
ABOUT THE TEAM: The Alliance Quality Improvement Department ensures the quality and effectiveness of care provided to our members. Our Quality Improvement Nurses develop, manage and measure comprehensive preventive healthcare strategies to promote best evidence based practices and improve member health outcomes. Our team is collaborative, committed and fun. We work hard, promote learning and encourage each other’s strengths in a professional and supportive work environment.
ABOUT YOU: In this role you will have the opportunity to ensure patient safety through Facility Site Review (FSR), Medical Record Review (MRR) and Physical Accessibility (PAR) audits, as well as conduct research and provide evidence based education and information to providers. This position may also investigate potential quality issues (PQI) that may affect the quality or safety of the health of members.
Ideal candidates will hold strong critical thinking and nursing judgment experience. Prior Primary Care office experience, Practice Coaching and Process Improvement experience is a plus. This role will require travel throughout our three covered counties of Santa Cruz, Salinas and Merced.
RESPONSIBILITIES: Under direction, this position develops, manages and measures a comprehensive preventive healthcare strategy in collaboration with internal stakeholders and network providers to promote best evidence based practices and improve member health outcomes; participates in local, regional and state audits and improvement initiatives to measure, analyze and improve member health outcomes; evaluates patient safety and quality issues by promoting an environment of transparency with internal stakeholders, network providers and community partners; and performs other duties as assigned.
YOU WILL BRING: • Knowledge of: - Medi-Cal, or managed care - Medical practice operations and healthcare delivery systems - NCQA HEDIS abstracting guidelines preferred - CPT and ICD coding principles preferred • Ability to: - Appropriately evaluate medical records and other health care data - Consistently apply clinical audit criteria with at least a 98% inter-rater reliability - Consistently enter the results of clinical audits into a database with at least a 98% inter-rater reliability - Demonstrate a strong orientation to a teamwork environment with a focus on customer satisfaction - Work independently and within multidisciplinary teams - Experience with the use of Windows-based PC applications with emphasis on word processing, database, and spreadsheet software (e.g., MS Word and Excel) preferred. • Education and Experience: - Current California Registered Nurse license required - Bachelor’s degree or equivalent experience in nursing, public health, health administration, or health related field preferred - Minimum of three (3) years in acute care or primary care with an emphasis in preventative care - Experience in process improvement, practice coaching or health care quality improvement preferred - Facility Site Review Certification preferred
BENEFITS: • Medical, Dental and Vision Plans • Generous Paid Time Off • 11 Paid Holidays per Year • 401(a) Retirement Plan • 457 Deferred Compensation Plan • Tuition Reimbursement • Costco Membership Reimbursement • Health and Wellness Program • Fresh Fruit Delivery • Electric Vehicle Charging Stations • And many more! (https://ccah-alliance.silkroad.com/map_images/main/SiteGen/ccahext/Content/Uploads/Unplaced_Documents/Benefits_Summary.pdf)
For a complete position description and to apply online, please visit our careers website at https://ccah-alliance.silkroad.com
If this sounds like an opportunity that you or someone you know may be interested in we invite you to apply! Applicants must be currently authorized to work in the United States on a full-time basis.
The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status.