Clinical Quality Assurance Nurse Analyst I

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Johns Hopkins Health Plans is a leader in provider-sponsored health plans. If you are interested in improving how healthcare is delivered, and have a passion to be at the forefront of change, JHHP is the place to call home. Johns Hopkins Health Plans (JHHP) is the managed care and health services business of Johns Hopkins Medicine. YOU belong here.

Who you are:

As the Clinical Quality Assurance Nurse Analyst for Johns Hopkins Health Plans, you play a crucial role in supporting our Managed Care Clinical Health Services team by ensuring adherence to high-quality standards through effective Quality Assurance (QA) practices and oversight. You understand the importance of your role as you collaborate with departmental management and key stakeholders, conducting quality audits, feedback sessions, and other quality audits for our Clinical team.

What awaits you:

• Work-life balance - This is a remote role! Must have MD active RN license.
• Medical, Dental, and Vision Insurance.
• 403B Savings Plan w/employer contribution.
• Paid Time off & Paid holidays.
• Employee and Dependent Tuition assistance benefits.
• Health and wellness programs and MORE!

What you'll do:

• Collaborate with departmental management and stakeholders to identify areas that require quality auditing oversight and monitoring.
• Assist in the development of monitoring activities to ensure compliance with quality standards.
• Prepare and analyze quality audit reports to identify data integrity issues, performance gaps, and process gaps.
• Conduct quality audits, feedback sessions, and other quality audit functions for Health Services staff.
• Participate in testing and QA of system changes as necessary.
• Collaborate with key stakeholders and Training Staff to provide feedback and contribute to the improvement of processes and procedures.
• Serve as a clinical expert in the development and evaluation of quality audit functions.
• Develop and maintain service level agreements, standard operating procedures, workflows, and educational materials.

What you'll bring:

• 5+ years' experience as a RN in an Acute HealthCare; managed care or health plans experience is preferred.
• Experience with or knowledge of Quality Measures
• Familiarity with utilization review, behavioral health, and/or clinical appeals and denials preferred
• Ability to effectively communicate, provide constructive feedback, and facilitate positive interdepartmental relationships
• Unencumbered RN license in Maryland (or Compact licensure)

Skills:

• Strong analytical and detail-oriented skills to organize/assess information;
• Problem solving skills to make recommendations based on data or authoritative resources
• Assess situations and respond appropriately by requesting training, documentation changes, and/or policy changes;
• Effectively communicate, provide constructive feedback, and facilitate positive interdepartmental relationships;
• Project a positive attitude and image by being professional, courteous, helpful and friendly in relationships with all levels of staff and management
• Work in multiple software applications and learn new applications quickly.
• Experience using Microsoft Office products required. Proficiency in reporting tools and databases such as Excel preferred.

Salary Range: Minimum 39.94/hour - Maximum 61.91/hour. Compensation will be commensurate with equity and experience for roles of similar scope and responsibility. In cases where the range is displayed as a $0 amount, salary discussions will occur during candidate screening calls, before any subsequent compensation discussion is held between the candidate and any hiring authority.

We are committed to creating a welcoming and inclusive environment, where we embrace and celebrate our differences, where all employees feel valued, contribute to our mission of serving the community, and engage in equitable healthcare delivery and workforce practices.

Johns Hopkins Health System and its affiliates are drug-free workplace employers.