Regulatory Quality RN Clinical Care-Intermediate

Presbyterian Healthcare Services

1d • $58,074 - $88,670 • Onsite

About The Position

Build your Career. Make a Difference. Presbyterian is hiring a skilled Regulatory Quality RN Clinical Care-Intermediate How you grow, learn and thrive matters here. • Educational and career development options, including tuition and certification reimbursement, scholarship opportunities • Staff Safety (a wearable badge that allows nurses to quickly and discreetly call for help when safety is a concern) • Differentials for night/weekend shifts, higher education, certifications and various lead roles (for eligible positions) • Malpractice liability insurance • Loan forgiveness through the New Mexico Higher Education Department • EPIC electronic charting system Presbyterian is seeking a Regulatory Quality RN Clinical Care-Intermediate Responsible for PH Quality of Clinical Care (QOCC) activities. Investigates complaints alleging inappropriate Physical Health (PH) clinical care or alleged inappropriate behavior by a physician or other health care practitioner/provider. Applies the knowledge of a registered nurse to determine the key factors in each case and whether the standard of care has been met, documenting and summarizing findings for all parties regarding investigative findings. Collaborates on quality of clinical care work with PHP Business Partners including Medical Directors, Provider Network Operations, Credentialing, Care Coordination, Critical Incidents Team, and Legal counsel. Assists the provider peer review process which assesses and reviews the quality of patient and member care provided by practitioners and facilities. We're all about well-being, starting with yours. Presbyterian employees have access to a fun, engaging and unique wellness program, including free on-site and community-based gyms, nutrition coaching and classes, mindfulness and meditation resources, wellness challenges and more. Learn more about our employee benefits. About Presbyterian Healthcare Services Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses. Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans. AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses. Compensation Disclaimer The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs. We're Determined to Support New Mexico's Well-Being | Presbyterian Healthcare Services Here, we’re committed to a different way to make a difference. Presbyterian's story is really the story of the remarkable people who have chosen to work here. Starting with Reverend Cooper who began our journey in 1908, the hard work of thousands of physicians, nurses, employees, board members, and volunteers brought Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system, serving more than one in three New Mexicans. We are part of New Mexico's history and committed to its future. That is why we will continue to work just as hard and care just as deeply to serve New Mexico for years to come.

Requirements

• Bachelors in Nursing
• Five years hospital nursing experience
• Current NM RN License
• Skills in Outlook, Word, Excel, and Power Point

Nice To Haves

• Critical Care experience
• Complaint Management experience
• Quality Improvement experience
• Care Coordination/Case Management experience

Responsibilities

• With guidance, reviews, responds to, and researches complaints related to quality of medical care utilizing a high level of knowledge and skill in nursing practice in order to discern the key factors in each case to ensure that all quality of care issues are identified and addressed.
• Provides referrals, as appropriate to the case, to correlating PHP entities including but not limited to: Legal, Risk Management, Behavioral Health QOCC Team, Provider Network Operations, Credentialing, Critical Incidents Teams, or Care Coordination.
• Perform Physical Health QOCC Case Management-all levels
• Conduct Practice Pattern Reviews
• Manage PIPs (Performance Improvement Plan)
• Conducts Medical Record Review (MRR)
• Prepare and Present Medical Director Reviews
• Attend Weekly Medical Records Huddle
• Writes QOCC Correspondence/Letters
• With guidance, writes and presents QOCC case summaries to PHP's Physical Health Professional Practice Evaluation Committee (PH PPEC).
• With guidance, manages and communicates PH PPEC recommendations including but not limited to: Practice Pattern Reviews, Performance Improvement Plans, and/or Recommendations for Terminations, Suspensions, or Admissions Holds.
• Other duties as assigned.

Benefits

• Educational and career development options, including tuition and certification reimbursement, scholarship opportunities
• Staff Safety (a wearable badge that allows nurses to quickly and discreetly call for help when safety is a concern)
• Differentials for night/weekend shifts, higher education, certifications and various lead roles (for eligible positions)
• Malpractice liability insurance
• Loan forgiveness through the New Mexico Higher Education Department
• EPIC electronic charting system
• Presbyterian employees have access to a fun, engaging and unique wellness program, including free on-site and community-based gyms, nutrition coaching and classes, mindfulness and meditation resources, wellness challenges and more.

What This Job Offers

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