RN / QUALITY MANAGER

UHS•Palmetto, FL

10h•Onsite

About The Position

This RN / Quality Manager position is full time on-site position, offer full benefits and a convenient day shift. The Quality Coordinator RN is a registered nurse who functions in a market quality leadership role in Population Health. This role helps drive quality best practices in a collaborative effort with payers, providers, support staff, managed care, VBC leaders and administration. The Quality Coordinator RN will participate in quality improvement initiatives, develop recommendations for quality remediation plans and create tools and databases to capture relevant data for their respective region. The QCRN will also be a leader for their local quality support team, with attention to apportioning responsibilities for quality support staff across their respective market. This role will also develop collaborative payer relationships to maximize resource utilization for patient care. Additionally, they will track quality performance on an ongoing basis with dissemination of performance metrics to key stakeholders (clinics, providers, administration) as a part of their leadership within a matrix relationship. The Quality Coordinator RN will be responsible for driving performance across plan metrics as outlined by the respective plans, optimize patient outcomes and system utilization, focus on STARS and HEDIS performance/metrics and help with MIPS measures. Additionally, the QCRN will help support quality staff competency and optimize clinic quality workflows within their region.

Requirements

Graduation from an accredited nursing education program.
Actively licensed by the worked in State to practice as a Registered Nurse.
Minimum of 5 years of associated Population Health/Quality experience within the health care industry, preferably ambulatory based and includes experience with HEDIS/STARS and MIPS
Bachelor’s Degree
Motivational Intervening
Shared Decision Making
Patient Centered Medical Home principles and Population Health principles (including care management, HEDIS/STARS and MIPS)
Must demonstrate knowledge and ability to work effectively with all levels of personnel
Knowledge of medical documentation requirements for meeting quality incentives
Demonstrates awareness of and use of appropriate body mechanics
Critical thinking, problem solving
Must possess excellent communication skills and demonstrate team leadership and interpersonal skills
Must have the ability to problem solve and think critically
Ability to work both independently and support a regional quality team
Operate within the concept of patient centered care
Ability to coach and mentor clinical and non-clinical staff
Standard office equipment (laptop computer, fax, copier scanner)
Pop Health/EMR software
Office or outpatient medical office setting
Works in a well-lighted, OSHA Standard environment
May be exposed to infectious and contagious diseases and bloodborne pathogens
May be in contact with patients under a wide variety of circumstances
Local ND domestic travel
Occasionally subject to irregular hours
May be required to wear personal protective equipment as necessaryEEO Statement

Nice To Haves

Master's Degree, preferred

Responsibilities

STARS/HEDIS and MIPS Performance
Participate in the development of an annual work plan for improvement of STAR ratings, HEDIS and MIPS capture/performance from the position of the leader of the market quality team.
Support system efforts that may include MSO initiatives, new payer contracts, and risk initiatives.
Help create and support quality-based clinic workflows geared towards capturing gaps in care (chart scrubbing, pre-charting, huddles, Patient Care Conferences (PCCs)
Support provider reviews of performance on a regular cadence (monthly preferable).
Participate in payer meetings, create appropriate JOCs with payers.
Analyze and evaluate provider group structure and characteristics, provider group/provider office operations and personnel to identify the most effective approaches and strategies
Optimizing HCC capture and appropriately maximizing RAF
Education of clinical staff concerning HCC capture and importance of RAF
Develop and implement strategies for maximization of attestation form completion.
Optimize AWV completion and promote as an opportunity for completing HCC capture
Longitudinal Care Coordination
Provide leadership of quality team in the ongoing development of quality and timely patient care across the care continuum
Develop collaborative relationships across the patient care spectrum in the pursuit of warm patient hand-offs and a seamless care experience.
Leadership of RN Care Managers and Population Health Coordinators within a collaborative environment, to maximize longitudinal care of the patients.