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Quality Management Nurse

Company: Dignity Health
Location: Redlands
Posted on: November 4, 2019

Job Description:


  • Serve as a key interface and liaison for the local participating physicians through collaboration with the local Medical Director, physician practice liaison, and local hospital quality management staff.
  • Responsible for physician education and training on processes and workflow related to clinical initiatives undertaken as a part of the CI Program, including CPTII coding and extracting data from Dignity Health databases and reporting tools the Intelligent Healthcare Business Intelligence (BI) Tool. This requires travel to provide on-site training in physician offices.
  • Working closely with Physician Practice Liaison, provide physician office staff education regarding support for physician in implementing clinical initiatives undertaken within the physicianas area of specialty.
  • Collaborate with physician practice liaison on data integrity.
  • 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 Quality Director, Executive Director, and 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 Quality Director, Executive Director and Medical Director.
  • Perform patient chart review to reconcile quality reporting results with chart documentation.
  • Provide Executive Director, Medical Director and Quality Director with support on performance improvement and development of remediation plans at the local service area Chapter level.
  • Support marketing and communications with materials relating to disease management programs.
  • Attend local quality management committee meetings, if requested by the Executive Director, Medical Director or Quality Director.
  • Assists the Executive Director, Medical Director or Quality Director with other duties as assigned.QualificationsMinimum Qualifications
    • Minimum 2 years experience in a quality management program in a managed care/health plan, IPA, hospital setting(s).
    • 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 or 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.Additional Required Qualifications
            • 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 staff and Hospital staff.Preferred QualificationsClick here to enter text.Equal Employment Opportunity

Keywords: Dignity Health, Redlands , Quality Management Nurse, Executive , Redlands, California

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