NO NIGHTS OR WEEKENDS | RN OR LPN LICENSE
Summary: North Central Family Medical Center is a non-profit Federally Qualified Health Center (FQHC) providing affordable, accessible healthcare and pharmacy services to patients of all ages with locations in Rock Hill and Chester.
Under the direction of the Quality Improvement Manager, the Quality Improvement Nurse is responsible for assisting North Central in its quality improvement efforts including development, implementation, education, data collection, and analysis.
Essential Duties and Responsibilities include the following. Other duties may be assigned.
- Develops, implements and monitors quality management policies and procedures for quality data collection and reporting on HEDIS and Gaps in Care Reports, UDS, Meaningful Use and PCMH measures
- Identifies best clinical and business practices within the offices. Recommends standardized systems and develops a plan to implement and monitor systems within and across the organization
- Helps quality improvement leader to plan, design, implement, and maintain a comprehensive medical practice continuous quality improvement (CQI) program to include utilization management and risk management
- Assists in educating new staff, including physicians, about QI systems and requirements
- Leads QI audits, prepares reports, and implements corrective action plans
- Meets with internal and external audiences to identify and problem solve QI issues
- Monitors medical practice efforts to ensure compliance with internal and external QI standards
- Reviews medical records and other documentation to ensure quality care. Helps to prepare annual QI report
- Coordinates the effort to extract/gather data and prepare reports to meet the requirements of NCQA and other regulatory/accrediting agencies, including patient satisfaction data
- Evaluates variance and other data to identify QI opportunities and risk management issues.
- Monitors utilization and service quality through diagnosis-related group (DRG) review, HEDIS quality measures, payer/provider/patient satisfaction surveys
- Supports and acts as liaisons with payers, providers, and patients and service as the primary patient information resource for payers
- Conducts ongoing assessments of the existing eligibility and referrals, case management, disease management systems, and Quality Management programs within each practice. Provides objective evaluation and recommendations for those systems
- Reviews existing practice information system capabilities for the tracking and monitoring of quality indicators.
- Makes the necessary adaptations for standardized reporting across all practices
- Reports audits requiring clinical judgment and expertise to the Medical Director, QA/QI Committee and other entities, as assigned
- Assist with developing and implementing Chronic Care Management Program for Medicare Population
- Assist with implementing and maintaining Chronic Disease Management Programs
Qualifications:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education/Experience:
- Graduate of an approved school/training program
- Minimum of 2 years of direct patient care in an ambulatory health care setting
- Knowledge of medical records and analysis of processes of clinical care in addition to exhibiting knowledge of familiarity with the HEDIS/STAR measures and standards
- Prefer 2 years’ experience in managed care or health care regulatory agency environment
- Prefer 2 years’ experience in utilization of management or quality improvement or chart abstraction for HEDIS/STAR
Certificates and Licenses:
- Valid SC license for LPN or RN
- CPR certification required
- Certified Professional in Healthcare Quality (CPHQ) preferred
Knowledge, Skills and Other Abilities:
- Ability to develop and maintain personable yet professional relationship with patients and staff
- Knowledge of CQI principles, practices, methods, and tools
- Knowledge of computer applications related to QI, including spreadsheets
- Knowledge of medical records and clinical care processes
- Knowledge of Chronic Care Management
- Knowledge of Plan, Do, Study, Act Process of Performance Improvement testing
- Knowledge of one or more of: clinical standards of care, preventive health standards, HEDIS, NCQA, governing and regulatory agency requirements, and the managed care industry
- Skill in effective education and facilitation of CQI efforts in medical practice
Job Type: Full-time
Pay: From $25.00 per hour
Expected hours: 40 per week
Benefits:
- 401(k) matching
- Dental insurance
- Disability insurance
- Health insurance
- License reimbursement
- Life insurance
- Paid time off
- Vision insurance
Physical setting:
Standard shift:
Weekly schedule:
Experience:
- Nursing: 2 years (Required)
License/Certification:
- BLS Certification (Required)
Ability to Commute:
- Rock Hill, SC 29730 (Required)
Ability to Relocate:
- Rock Hill, SC 29730: Relocate before starting work (Required)
Work Location: In person