Clinical Quality of Care Coordinator

Presbyterian Healthcare Services

2d • $60,986 - $103,813 • Onsite

About The Position

The Clinical Quality of Care Coordinator is responsible for quality of clinical care activities, including coordinating the provider peer review process to assess and review the quality of care provided by direct care providers and facilities. The coordinator investigates complaints alleging inappropriate clinical care or behavior by physicians and other healthcare practitioners, applies registered nursing knowledge to assess relevant factors and standards of care, and documents and summarizes findings for involved parties. The role collaborates with medical directors, registered nurses, legal counsel, and other internal stakeholders.

The position is based at the Reverend Hugh Cooper Administrative Center in Albuquerque, New Mexico, and is a full-time, exempt role on the day shift. It coordinates quality-of-care data tracking and reporting, complaint investigation and referrals, peer review activity, process development, training, and performance improvement efforts. The coordinator advises leadership on opportunities to improve patient safety, outcomes, and financial performance.

Requirements

• Current New Mexico RN license.
• Bachelor’s degree required.
• Three to five years of experience in a clinical nursing field.
• Excellent written, oral, and facilitation skills.
• Skills in Word, Excel, and PowerPoint.
• Ability to work with highly sensitive and confidential information.

Nice To Haves

• Bachelor of Science in Nursing (BSN) preferred.
• Three years of quality-improvement experience preferred.
• Three years of case-management or care-coordination experience preferred.

Responsibilities

• Coordinate tracking and trending of quality-of-care data and report findings to internal committees and external agencies.
• Collaborate closely with internal stakeholders.
• Develop and refine processes, policies, procedures, and desktop tools; support change initiatives and the department strategic plan.
• Review, respond to, and research medical-care quality complaints, identify and address quality-of-care issues, and refer matters to Legal/Risk Management, Health Services Care Coordination, or Provider Network Management as appropriate.
• Present case facts and recommendations to the Peer Review Committee and take action based on committee decisions, including practitioner chart reviews to evaluate practice patterns and performance against standards of care and peer-group performance.
• Develop and maintain an enterprise process for sharing practitioner quality-of-care information in collaboration with legal, credentialing, medical staff affairs, provider network management, and the medical group.
• Develop and maintain internal and external peer-review processes in consultation with legal, including identifying and contacting external reviewers, arranging payment, and coordinating review logistics.
• Manage the quality-of-care database for occurrence screening, reporting, and network monitoring; use data to guide decisions and performance-improvement strategies.
• Develop training materials addressing individual and network-wide improvement opportunities and collaborate with Provider Services staff on effective implementation.
• Advise leadership about system-process improvements to maximize patient safety, optimize outcomes, and minimize financial loss; participate in process-improvement teams as appropriate.
• Perform other functions as required, including cross-training with Critical Incidents and clinical quality projects.

Benefits

• Medical, dental, and vision insurance.
• Short-term and long-term disability insurance.
• Group term life insurance and other optional voluntary benefits.
• Employee Wellness rewards program, with opportunities to earn gift cards through wellness activities.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level