Registered Nurse-Quality of Care

CareOregon • WFH (Oregon), OR

9d • $102,330 - $125,070 • Hybrid

About The Position

The Registered Nurse - Quality of Care main function is to manage internal quality of care referrals and support other quality efforts under Clinical Services and CareOregon Quality Health Outcomes quality initiatives.

Requirements

• Minimum 3 years of experience as an RN in the healthcare industry
• Current unrestricted license as a registered nurse in the State of Oregon
• Competency with computers and software programs, e.g. PDF, MS Outlook, Word, Excel and EMR systems
• Ability to learn and adapt to new EMR systems, software programs, specification changes and deadlines
• Ability to maintain strict confidentiality of protected health information
• Awareness of the social determinants of health impacting CareOregon members and approaching interactions with clinics, members or CareOregon embedded staff with kindness and friendliness
• Ability to work in an environment with diverse individuals and groups
• Have a high degree of initiative and motivation along with ability to effectively collaborate and plan with co-workers and others
• Ability to manage multiple tasks and flexibility to switch tasks as needed
• Act professionally at all times when representing CareOregon
• Ability to work under pressure and help the team meet deadlines for regulatory deliverables
• Good written and verbal communication skills
• Excellent customer service skills and ability to work across multiple departments
• Ability to prioritize work in a remote environment
• Ability to work effectively with diverse individuals and groups
• Ability to learn, focus, understand, and evaluate information and determine appropriate actions
• Ability to accept direction and feedback, as well as tolerate and manage stress

Nice To Haves

• Bachelor’s degree in Nursing
• Prior primary care and/or specialty clinic practice experience and behavioral health experience highly desired
• RN experience with quality improvement, population health and/or case management
• Knowledge of or desire to learn about current clinical practices specifically issues related to quality of care for our members

Responsibilities

• Complete Quality of Care reviews.
• Work closely with the director of Quality of Care to ensure quality and clinical issues are addressed in a timely and thorough manner.
• Maintain accurate and complete documentation for files related to quality of care.
• Utilize enterprise tools such as QNXT, Sharepoint and smartsheets to aid in quality monitoring.
• Coordinate and facilitate risk reduction strategies for quality and patient safety issues when opportunities are identified.
• Collaborate with other departments in ensuring quality of care process is working effectively.
• Conduct annual and other trainings as needed.
• Take lead in the implementation and ongoing administration of health improvement programs and provide ongoing feedback to Quality of Care Director and others as appropriate.
• Identify education/ training programs for network providers, members, other health care workers and CareOregon staff in support of appeals and grievance process.
• Develop and monitor a tracking system to ensure accuracy of data, tracking and trending of providers with quality of care issues and other possible data sources related to clinical quality.
• Provide clinical expertise to other department members, in evaluation of program outcomes, providing input for program activities.
• Ability to apply CMS, OAR, Contract Requirements and other regulatory standards when performing work.
• Apply the Equity First approach when conducting work and participate in helping to develop and implement the Equity First approach.
• Participate in committees such as contract review, peer review and quality oversight as needed.
• Participate in Provider site visits as needed.

Benefits

• competitive pay
• bonus opportunity
• medical, dental, vision, life, AD&D, and disability insurance
• health savings account
• flexible spending account(s)
• lifestyle spending account
• employee assistance program
• wellness program
• discounts
• multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.)
• strong retirement plan with employer contributions
• PTO
• Paid State Sick Time
• paid holidays
• volunteer time
• jury duty
• bereavement leave

What This Job Offers

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