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Quality Improvement Nurse, South San Francisco, CA

Health Plan of San Mateo


South San Francisco, CA

April 10, 2017


The Health Plan of San Mateo (HPSM), a managed care health plan, seeks a full time Quality Improvement Nurse to conduct studies and analyze data to evaluate the performance of Health Plan of San Mateo (HPSM) in key clinical preventive and chronic care measures. This position will identify and implement interventions to improve performance and develop program goals and plans to meet HPSM’s internal quality goals as well as the needs of external regulatory and oversight entities. The essential duties and responsibilities will include the following:

  • Perform computer-based statistical analysis of data related to the QI program and collect data from one or more sources including outpatient lab, claims and other data sources.
  • Monitor and ensure the validity of data, utilize Plan data systems to generate, manipulate and analyze data, as well as evaluate reports for accuracy of data.
  • Perform analysis to determine statistically significant trends in the data compared to industry standards and recognized benchmarks.
  • Create process documentation for QI and/or HEDIS activities and collaborates with practices to integrate their electronic medical record data into HPSM systems.
  • Collaborate with internal and external stakeholders to identify and act on opportunities for improvement in the area(s) of chronic and/or preventive care.
  • Evaluate, monitor, and report compliance rates on a quarterly basis.
  • Analyze, develop and implement improvement activities to increase compliance rates as measured by nationally standardized benchmarks and definitions.
  • Perform oversight activities on entities with Plan delegated functions.
  • Regularly audit entities with Plan delegated functions.
  • Develop, implement, and follow up with corrective action plans.


License and Certification: A valid California license as a Registered Nurse (unrestricted and in good standing)

Education and Experience: Bachelor’s degree in nursing or a related health services field is a plus. Two (2+) plus years of relevant nursing experience in a managed care/quality improvement type of setting.

Knowledge of: Thorough knowledge of the principles and methods of research methodology, statistical analysis and report design (preferred). Strong knowledge of HEDIS reporting. Strong knowledge of Medicare and Star ratings (strongly preferred). Strong understanding of relational databases. The concepts of managed health care. Title 22 regulations (preferred). Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, Access and PowerPoint.

Ability to: Evaluate medical records and other health care data. Communicate effectively both orally and in writing. Plan, organize and lead data collection activities. Resolve simple and/or complex analytical problems. Present statistical and technical data in a clear and understandable manner utilizing appropriate visual aids. Establish and maintain effective and cooperative working relationship with HPSM staff and others contacted in the course of the work. Maintain accurate records and confidentiality of sensitive medical information. Assume responsibility and exercise good judgment in making decisions within the scope of authority of the position. Accurately complete tasks within established times and to effectively prioritize multiple tasks and deadlines.

Starting Compensation Range: Between $40.86/hour-$48.07/hour - depending on experience.

Other: Must have own car, unrestricted driver’s license and insurance in conformity with California state law minimums.

Benefits Information: Excellent benefits package offered, including HPSM paid premiums for employee’s coverage in the medical HMO plan and majority of PPO medical cost. Employee pays a small portion of the dependent premiums for medical and dental benefits. Additional HPSM benefits include fully paid vision, life, AD&D, STD, and LTD insurance; retirement plan (10% of salary for compensation/HPSM paid); holiday and vacation pay; tuition reimbursement plan; and more.

Application Process: To apply, submit a resume and cover letter with salary expectations to: Health Plan of San Mateo, Human Resources Department, 801 Gateway Blvd., Suite 100, South San Francisco, CA 94080 or via email: or via fax: (650) 616-8039. File by: Continuous until filled. EOE

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