Quality Management Nurse

Job ID
2020-118073
Employment Type
Full Time
Department
Quality Management
Hours / Pay Period
80
Facility
Dignity Health Management Services Organization
Shift
Day
Standard Hours
Mon-Fri (8-5 PM)
Work Schedule
8 Hour
Location
CA-Scotts Valley

Overview

Dignity Health Medical Network (DHMN) and Santa Cruz Quality Care Network are local, physician led networks of healthcare providers and hospitals working together to provide patients with a team-based approach to care which is innovative and inclusive. We are committed to bringing quality health care, expertise, and value to our patients by focusing on patients’ access to prevention, care coordination and chronic condition management. A critical member of this team-based quality focused care is the Quality Management Nurse.  The Quality Management Nurse will work closely and collaboratively with outpatient and inpatient partners to improve the quality of the care delivered across the care continuum.

 

DHMN-SC and SCQCN are supported by Dignity Health Management Services (Dignity Health MSO).  The purpose Dignity Health MSO is to build a system-wide integrated physician-centric, full-service management service organization structure. Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art, flexible Health & Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options, including medical, dental and vision plans, for the employee and their dependents, Health Spending Account (HSA), Life Insurance and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave.

Responsibilities

The Quality Management Nurse provides direct local service area support to the Clinical Integration (CI) program.  The QM Nurse reports to the SCQCN Executive Director and is an employee of Dignity Health Managed Services Organization. The QM Nurse provides local support to the CI Program through continuous interaction and education with the participating physicians and mid-level providers, as well as hospital QM staff.

 

PRINCIPLE DUTIES AND RESPONSIBILITIES:

  • Serve as a key interface and liaison for the local participating physicians through collaboration with the Executive Director, physician practice liaison, and other key members of the SCQCN leadership team.
  • Responsible for physician education and training on processes and workflow related to clinical initiatives undertaken as a part of the CI Program, including CPTII and HCPCS coding, documenting quality data in paper and electronic charts, and reporting via the dashboard. This requires travel to provide on-site training in physician offices.
  • Working closely with Physician Practice Liaison to provide physician office staff education regarding support for physician in implementing clinical initiatives undertaken within the physician’s area of specialty.
  • Collaborate with Physician Practice Liaison by developing proficiency in understanding quality data extracts and reporting.
  • Collaborate with the Physician Practice Liaison in analysis, monitoring and interpretation of ambulatory clinical quality data, using dashboard reports.
  • Provide one-on-one education on use of dashboard reports and other communications as appropriate to identify potential improvements and assist physicians in understanding methods and processes required to achieve measurable results.
  • Collaborate with the Executive Director and SCQCN Chief Medical Officer (CMO)/Medical Director in preparing analyses, as well as monitoring, interpreting, and educating on results of clinical (ambulatory and hospital) quality, cost and utilization data.
  • Responsible for monitoring and evaluating physician compliance and performance with quality standards, as identified in weekly, monthly and quarterly reports and provide feedback to the Executive Director.
  • Perform patient chart review to reconcile quality reporting results with chart documentation, using a sampling methodology approved by the Board of Managers.
  • Provide Executive Director with support on performance improvement and development of remediation plans at the local service area level.
  • Support marketing and communications with materials relating to disease management programs.
  • Attend local quality management committee meetings, if requested by the Executive Director.
  • Assists the Executive Director with other duties as assigned.

 

 

#MISSIONCRITICAL

Qualifications

EXPERIENCE:

  • 1- 2 years experience in a quality management program in a managed care/health plan, IPA, hospital setting(s) preferred
  • Must possess a keen working knowledge of Medical Management process improvement activities (QM Programs, Pay-for-Performance measures), including analysis of qualitative and quantitative clinical data concerning patient outcomes, to ensure the highest quality care is documented consistent with the CI Program guidelines. Experience navigating through patient information in an Electronic Medical Record (EMR) application in the ambulatory setting.

EDUCATION AND TRAINING:

  • Degree from college or university nursing program.

 

LICENSE, CERTIFICATION AND REGISTRATION:

  • Current registered nurse or licensed vocational nurse licensed in the State of California.

 

SPECIALIZED KNOWLEDGE AND SKILLS:

  • Demonstrated skills in the areas of written and verbal communication, judgment, problem-solving, presentation and public relations. 

 

OTHER REQUIREMENTS:

  • This position requires a dynamic and highly motivated person with the ability to inspire and lead people, as well as communicate effectively with employees, Physicians, other Management Service Organization Administrators and Hospital staff.

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