Quality Improvement Specialist (RN) - The Health Plan

Position: Quality Improvement Specialist (RN) - The Health Plan

Job ID: 140803

Location: US-TX-Houston

Department: STAR KIDS - ADMIN

Talent Area: Registered Nurse

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: 8a - 5p

About Texas Children's Hospital

Founded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.   To join our community of 13,000 dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org.


We are searching for a Quality Improvement Specialist - someone who works well in a fast-paced hospital setting. In this position, you’ll support the development and implementation of the Quality Improvement Program for Texas Children’s Health Plan. You will implement policies and processes in compliance with all applicable federal, state, and nationally recognized accrediting bodies, as well as assist in the reporting of all required quality data to ensure compliance.

Think you’ve got what it takes?

Responsibilities :

Assures required Quality Improvement Program information needs are met

Provides formal input towards the development of action plans or other follow up activities related to data collection activities

Performs outreach and intervention to providers

Accountable for at least a portion of the identification, staff education, completion, record keeping, reporting, and evaluation of the quality of care complaint process

Assists in all required projects as directed to meet departmental objectives


Bachelor of Science in Nursing, Associate Degree in Nursing, or Diploma in Nursing (Bachelor of Science in Nursing is preferred)

Registered Nurse (RN) license granted by the Texas Board of Nursing

Three (3) years of managed care/quality improvement experience

Knowledge of managed care principles and practices

Knowledge of NCQA, JCAHO, state and federal regulatory HMO regulations

Group process and problem solving facilitator training is helpful

AHIP managed care course work and CPHQ certification highly desirable

Ability to effectively communicate complex principles, as well as other information, to a variety of audiences, both verbally and in writing

Team building and exemplary interpersonal skills

Strong individual initiative and risk taking skills are necessary for the candidate to be successful in the areas of identification, solution generation, and outcome driven behavior/process change

Strong computer skills for applications such as word processing and spreadsheets


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