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Developmental Disability Caregiver

CalOptima

Developmental Disability Caregiver

Orange, CA
Full Time
Paid
  • Responsibilities

    DEPARTMENT(S):  Quality Improvement REPORTS TO:  Supervisor, Quality Improvement (PQI) FLSA STATUS:  Non-Exempt SALARY GRADE:  M - $40.87 - $63.99 ($85,000 - $133,100)

     

    PARTIAL TELEWORKTHIS POSITION IS A PARTIAL REMOTE OPPORTUNITY FOR SOUTHERN CALIFORNIA APPLICANTS. IN ORDER TO BE CONSIDERED, YOU MUST LIVE IN SOUTHERN CALIFORNIA OR BE WILLING TO RELOCATE.

     

    JOB SUMMARY:

    The QI Nurse Specialist-Potential Quality Issue (PQI) is responsible for participating in managing the organization's clinical grievance review process including investigation of all quality reviews for potential quality of care concerns.  The incumbent will be involved with the collection of appropriate data and closing cases by preparing and submitting the cases to the appropriate physician reviewer and committees for closure. The incumbent ensures grievances/complaints are processed in accordance with regulations, compliance standards and policies and procedures.

     

    POSITION RESPONSIBILITIES:

    • Meets timeframes for performance while balancing the need to produce high quality work related to complex and sensitive member issues.
    • Ensures integrity of departmental database by thorough, timely and accurate entry of cases.
    • Participates in departmental meetings, trainings, and audits as requested.
    • Assists with the intake of cases in the department.
    • Carries out the monthly grievance reports.
    • Performs investigations of unusual occurrences/events from sources (providers, staff, hotline, etc.) and assesses the criticality of events.
    • Manages and supports a culture of compliance, ethics, and integrity.
    • Maintains knowledge of policies and procedures and performs in accordance with applicable regulatory requirements, external laws, and accreditation standards as they relate to business and clinical risk management.
    • Other projects and duties as assigned.

     

    POSSESSES THE ABILITY TO:

    • Communicate clearly and concisely, both verbally and in writing.
    • Demonstrate critical thinking, influencing, problem solving, and analytical skills.
    • Collaborate with other professionals.
    • Establish and maintain effective working relationships with CalOptima leadership and staff.
    • Travel as required for special projects.
    • Utilize and access computer and appropriate software (e.g. Microsoft: Word, Excel, Access) and job-specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position.

     

    EXPERIENCE & EDUCATION:

    • Bachelor’s degree in Health Services, Public Health, Business (with quantitative emphasis), Nursing, or other related field and/or equivalent work experience in clinical grievance review required.
    • Current unrestricted RN (Registered Nurse) or LVN (Licensed Vocational Nurse) license to practice in the state of California required.
    • 5 years of patient care or other health care experience required, preferably in a managed care setting.

     

     

    PREFERRED QUALIFICATIONS:

    • Certification in Case Management (CCM) or Certified Professional in Healthcare Quality (CPHQ) preferred.
    • Project management skills preferred.

     

    KNOWLEDGE OF:

    • Regulatory and Accreditation standards and guidelines (DHCS, DMHC, NCQA, Joint Commission, CMS).
    • Regulatory (Federal & State) laws pertaining to health care and reporting requirements of resource management.

     

     

     

     

    CalOptima is an equal employment opportunity employer and makes all employment decisions on the basis of merit. CalOptima wants to have qualified employees in every job position. CalOptima prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics._ _

    If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability.  You can request reasonable accommodations by contacting Human Resources Disability Management at 657-900-1134.

    Required Skills Required Experience

  • Qualifications
    • Ability to lead account transition, startup, and team building for new accounts.
    • Ability to successfully create, document, track and manage business initiatives.
    • Capable of leading the rollout, and delivery of services at a new account.
    • Consummate 'relationship manager.’ Evidenced by client understanding (scope adherence), process alignment, and issue avoidance.
    • Excellent verbal and written communication skills required.
    • English language proficiency.
    • Strong problem solving and analytical skills; Knowledge and ability to use analytical and problem-solving techniques.
    • Ability to complete tasks and produce deliverables independently with minimal supervision.
    • Write client reports and deliverable text clearly and comprehensibly, with some assistance.
    • Intermediate IWMS/CAFM principle understanding.
    • Some understanding of linkage between RE planning & financial results, and with guidance is capable of tailoring strategic direction to address financial challenges.
    • Capable of participating in discussions with customer on RE strategies and space use concepts.
    • Distills complex information to the essential for client decision-making.
    • Solid understanding of current workplace planning theories.
    • Use PowerPoint at an advanced level.
    • Strong analysis and spreadsheet capabilities; uses Excel at an intermediate level.
    • Solid computer skills in Microsoft Word, Outlook.
    • Basic AutoCAD skills.