Quality Management Nurse - Value Based Programs

San Bernardino County • Colton, CA

4h

About The Position

Arrowhead Regional Medical Center (ARMC) is hiring for a Quality Management Nurse - Value Based Programs. This role involves the ongoing review of patient-level detail (PLD) files for Quality Incentive Pool (QIP) metrics, auditing charting and documentation for outpatient services and inpatient stays, and identifying charting and coding gaps or errors that require remediation. This position offers a unique opportunity to combine clinical expertise, data analysis, and quality improvement within a dynamic public healthcare environment. The official job title is Quality Management Nurse. Duties may include, but are not limited to, performing ongoing review of patient-level detail (PLD) files related to Quality Incentive Pool (QIP) metrics, conducting chart audits and reviewing clinical documentation associated with outpatient services and inpatient stays, identifying charting and coding gaps or errors requiring remediation, analyzing quality metric performance and providing meaningful clinical insight based on assigned programs, collaborating with clinical and administrative teams to support accurate documentation and quality improvement efforts, coordinating education and training for providers and clinical staff related to quality metrics, participating in clinical process improvement efforts related to Value-Based Programs (VBP) metrics, and contributing to a holistic understanding of ARMC’s quality performance and compliance with regulatory requirements. The role also involves analyzing performance for all active value-based programs, including the Quality Incentive Pool (QIP) and IEHP Pay for Performance (P4P) programs, and HEDIS measures.

Requirements

• Must possess and maintain licensure as a Registered Nurse with the State of California Board of Registered Nursing.
• Healthcare Provider level Basic Life Support certification issued by the American Heart Association.
• OPTION 1: One (1) year of full-time equivalent experience in direct patient care as a Registered Nurse in an acute care hospital, primary care clinic, or Medicaid plan.
• OPTION 2: Two (2) years of full-time equivalent experience as a Registered Nurse in an acute care hospital, primary care clinic, or Medicaid plan with experience in performance improvement, quality management and/or patient safety, case management, utilization review/utilization management, or care coordination.

Nice To Haves

• Experience reviewing quality metrics for a Designated Public Hospital (DPH), primary care clinic, or Medicaid plan, or experience in case management, utilization review, or clinical documentation review involving chart audits, coding validation, or medical record abstraction.

Responsibilities

• Perform ongoing review of patient-level detail (PLD) files related to Quality Incentive Pool (QIP) metrics.
• Conduct chart audits and review clinical documentation associated with outpatient services and inpatient stays.
• Identify charting and coding gaps or errors requiring remediation.
• Analyze quality metric performance and provide meaningful clinical insight based on assigned programs.
• Collaborate with clinical and administrative teams to support accurate documentation and quality improvement efforts.
• Coordinate education and training for providers and clinical staff related to quality metrics.
• Participate in clinical process improvement efforts related to Value-Based Programs (VBP) metrics.
• Contribute to a holistic understanding of ARMC’s quality performance and compliance with regulatory requirements.
• Analyze performance for all active value-based programs, including, but not limited to, the Quality Incentive Pool (QIP) and IEHP Pay for Performance (P4P) programs, including HEDIS measures.

Benefits

• To review job-specific benefits, refer to: Summary of Benefits Nurses Unit and the Memoranda of Understanding (MOU).
• The County also offers an alternative Modified Benefits Option (MBO) that provides a wage differential.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed