Registered Nurse-Quality Specialist (RN)|Mck Quality Risk Mgmt at Abarca Health

Sioux Falls, South Dakota, United States

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$63,440 – $95,160Compensation

Mid-level (3 to 4 years), Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, HospitalIndustries

Requirements

Registered Nurse (RN) - active license in the state of practice upon hire
Visual acuity adequate to perform position duties
Ability to communicate effectively with others, hear, understand, and distinguish speech and other sounds
Preferred: 1-3 years nursing experience in a clinical setting
Commitment to Avera’s mission, vision, core values, and social principles
Uphold Avera’s standards of Communication, Attitude, Responsiveness, and Engagement (CARE)
Maintain confidentiality
Work effectively in a team environment
Comply with safety principles, laws, regulations, and standards (e.g., CMS, The Joint Commission, DHHS, OSHA)

Responsibilities

Guide the department in improving clinical effectiveness and compliance with state and national evidence-based indicators
Serve as the expert on clinic quality initiatives and stay current on national or state-level changes
Lead quality improvement initiatives in all ambulatory settings
Work with vendors to ensure data is accurately abstracted and submitted according to protocols
Coordinate submission plans with IT, fiscal, and medical records as required
Conduct quality reviews for clinical components to identify concerns, improvement opportunities, and trends; create process improvement strategies
Conduct in-services and outreach education on performance improvement and best practices
Educate organizational leadership (staff and physicians) on federal and state quality projects and outcomes
Meet all submission timelines and ensure validation scores comply with national requirements
Participate in validation processes to implement changes and measure success
Develop and provide appropriate tools (forms, worksheets) for staff compliance with quality requirements
Collaborate with department leaders to ensure proper data collection and problem-solve issues with benchmarks
Act as the liaison to the system for all ambulatory quality matters

Skills

Registered Nurse

Quality Improvement

Risk Management

Data Abstraction

Compliance

Process Improvement

Performance Improvement

Healthcare Quality

Evidence-Based Indicators

Validation

In-services

Outreach Education

Abarca Health

Pharmacy Benefit Management services provider

About Abarca Health

Abarca Health provides Pharmacy Benefit Management (PBM) services, focusing on flexible and user-friendly solutions for health plans, employers, and government programs like Medicare and Medicaid. Its main product, the Darwin platform, allows clients to quickly implement and modify benefit designs while ensuring compliance with regulations. Abarca Health manages over $5.3 billion in drug spend and processes 100 million prescription claims annually, offering additional services like home delivery for prescriptions. The company's goal is to deliver exceptional service and innovative solutions in the PBM market.

Aventura, FloridaHeadquarters

2005Year Founded

VENTURE_UNKNOWNCompany Stage

HealthcareIndustries

501-1,000Employees

Benefits

PTO

Parental leave

Work flexibility

Health insurance

Wellness stipend

401k

Tuition reimbursement

Leadership development programs

Risks

Increased competition from Amazon Pharmacy and Mark Cuban's Cost Plus Drug Company.

Growing focus on specialty drugs may require platform adaptation.

Shift towards price transparency could pressure Abarca's pricing models.

Differentiation

Abarca Health's Darwin platform is highly adaptable and user-friendly.

The company offers innovative programs like Triple S en Casa for home delivery.

Abarca Health ensures compliance with ever-changing healthcare regulations.

Upsides

Abarca transitioned two million members to Darwin in 18 months, showing operational efficiency.

Collaboration with Blue Shield of California boosts Abarca's reputation in the PBM sector.

Recognition as a top IT workplace attracts top talent, driving innovation.

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