RN, QUALITY COORDINATOR - ENID, Oklahoma - Case Management

Company: St Mary's Physician Associates
Location: Enid
Posted on: January 6, 2022

Job Description:

ResponsibilitiesThe Quality Coordinator RN is a registered nurse who functions in a market quality leadership role in Population Health. S/he 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. S/he 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.--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, risk initiatives, etc.
• Help create and support quality-based clinic workflows geared towards capturing gaps in care (chart scrubbing, pre-charting, huddles, Patient Care Conferences (PCCs)
• Support in-person 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
• Pursue 4+ STAR performanceOptimizing 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 captureTransitions of Care (TOC)
    • Utilizing appropriate quality team personnel for the following:o Contact of high risk patients within 2 business days of discharge to assure a safe landingo Completion of Medication Reconciliationo Assessment for community resources at home and attempt arrangement of serviceso Help foster a patient centered care plan to avoid hospitalizations and emergency department visitso Pursue appointments in clinic within 7 days for discharge patientso Utilize staff to pursue follow up with patients for 30 days post discharge as clinically necessaryo Mentors and coaches clinic staff in managing low and high risk patientsLongitudinal 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 patientsAnalytics
        • As a leader of the market quality team, develop a plan for maximizing VBC (Value Based Care) performance
        • Ability to communicate population health data to the care team, clinics/providers and administration
        • Identify opportunities for quality performance improvement within the market after analysis of available dataEffective problem solving, process improvement and decision making
          • Advanced knowledge of evidence based best practice in chronic disease management
          • Critical; thinking skills
          • Principles of process improvement
          • Utilize principles of change management to assist the clinics to move to a patient centered, population health approach within a primary care setting
          • Ability to positively influence others in the optimal care of patients and their ongoing needsOther duties as assigned.QualificationsEducationGraduation from an accredited nursing education program. Licensed by the State (within the state in which service is being performed) to practice as a Registered Nurse. Training in Motivational Interviewing preferred--Work ExperienceMinimum 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--KnowledgeMotivational Intervening, Shared Decision Making, Patient Centered Medical Home principles and Population Health principles (including care management, HEDIS/STARS and MIPS)--SkillsCritical thinking, problem solving, ability to work both independently and lead a market level quality team, and ability to coach and mentor clinical and non-clinical staff--AbilitiesOperate within the concept of patient centered care--Equipment OperatedStandard office equipment (laptop computer, fax, copier scanner), Pop Health/EMR software--Work EnvironmentOutpatient medical office setting--Mental/Physical RequirementsProlonged periods of sitting, multisite visits--EEO StatementAll UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws. We believe that diversity and inclusion among our teammates is critical to our success.--NoticeAt UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skillset and experience with the best possible career path at UHS and our subsidiaries.-- We take pride in creating a highly efficient and best in class candidate experience. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. If you are suspicious of a job posting or job-related email mentioning UHS or its subsidiaries, let us know by contacting us at: https://uhs.alertline.com or 1-800-852-3449.

Keywords: St Mary's Physician Associates, Enid , RN, QUALITY COORDINATOR - ENID, Oklahoma - Case Management, Executive , Enid, Oklahoma