Working with a dedicated and committed team, the Performance Improvement Clinical Specialist (PICS) is responsible for assessing and improving the quality of care provided by the providers serving our members.
Peer Review/Quality Assurance
Facility Site Review
Quality Improvement Team
OTHER DUTIES AND RESPONSIBILITIES
Education and Experience
Required: BSN or baccalaureate degree in an applicable field. Minimum three (3) years clinical experience.
Desirable: Experience in quality improvement or quality management, managed care; facility site review; HEDIS and Title 22.
Special Skills, Licenses and Certifications
Required: Current California Registered Nurse license. Knowledge of healthcare total quality management theory, practices, standards and applicable laws. Ability to access data and information using electronic record systems. Valid California Driver's license.
Desirable: Knowledge of NCQA/HEDIS standards. Familiarity with business practices and protocols.
Performance Based Competencies
Proficiency in MS Word and Excel. Excellent oral and written communication skills. Ability to facilitate groups and tasks. Excellent planning and organizational skills. Efficient; follows-through on commitments; attention to details. Flexible and adaptable to competing priorities, strong team player and able to remain calm under pressure.
Work Environment And Physical Demands
Must be able to work in a fast paced environment and maintain courtesy and composure when dealing with internal and external customers: Ability to prioritize work load and initiate action. Ability to function effectively with frequent interruptions and directions from multiple team members. Standard cubicle work station with shared common area. Use of telephone, fax, computer and photocopying machine is required. Requires sitting in front of computer equipment and talking on telephone for major portion of the workday. Must be able to move, lift or carry objects varying in size, weighing up to 35 lbs. Must be able to operate a vehicle used for company business.
All Healthplan employees are expected to:
The job duties, elements, responsibilities, skills, functions, experience, education factors and the requirements and conditions listed in this job description are representative only and not exhaustive of the tasks that an employee may be required to perform. The Employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive, or work environment change.