RN -Regulatory Quality Clinical Care

Presbyterian Healthcare Services

1d • Onsite

About The Position

Presbyterian is hiring a skilled Regulatory Quality RN Clinical Care-Intermediate. This role is responsible for PH Quality of Clinical Care (QOCC) activities. The position investigates complaints alleging inappropriate Physical Health (PH) clinical care or alleged inappropriate behavior by a physician or other health care practitioner/provider. The RN applies knowledge of nursing practice 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. This role 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. The RN also assists the provider peer review process which assesses and reviews the quality of patient and member care provided by practitioners and facilities.

Requirements

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

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
• 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