Job Description

Job Summary

As a member of the MVHS Care Management clinical team, the Quality Coordinator RN uses patient-centered assessments and care coordination to help the company achieve state determined quality metrics. The Quality Coordinator RN is responsible for auditing and monitoring documentation in member charts, educating clinicians and member facing staff. Educates staff on best practices and insurance/regulatory requirements. The Quality Coordinator RN will also perform member assessments. Plans, coordinates and supervises all healthcare plan services for members. Collaborates with member, family, physician, social worker and service providers to ensure appropriate care for achievement of healthcare plan goals and objectives.

Core Job Responsibilities

• Coordinate quality and performance improvement activities with MVHS Care Management staff and department leaders.
• Perform audits on member chart documentation for completion and compliance under current guidelines.
• Identify and review adverse outcomes for root cause. Review charts to ensure appropriate preventative measures and follow-ups are in place to drive improvement in the future. 
• Review gaps in process or documentation with leadership. Identify opportunities for improvement. Develop/present staff education materials in conjunction with the leadership team. 
• With leadership, implement action plans as well as monitor action plan effectiveness.
• Initiate and develop staff education based on audit findings.
• Serve as a subject matter expert on best practices in documentation and care management practices.
• Coordinate quality and regulatory activities and performance improvement actions with managers and leaders. 
• Compile data/creates reports for quality and performance improvement activities.
• Interpret and implement practices related to federal, state, local regulations and credentialing standards. 
• Carry Care Management caseloads
• Contains costs when ordering member supplies, services and DME.
• Assist with other healthcare plan development and marketing activities.
• Maintain and comply with regulatory requirements.
• Perform related duties as directed.
  
   

Education/Experience Requirements

REQUIRED:

• Graduate of an accredited school of nursing.
• Minimum of 3 years of professional nursing. 
• Demonstrated leadership abilities.
• Ability to organize and implement plans, efficient and flexible in problem solving.
• Able to motivate and educate members.
• Strong written, verbal and interpersonal communication skills.
• Proficient computer skills necessary.
• Ability to travel to patient residences within the region in all types of weather conditions.
  
   

PREFERRED:

• Experience in quality improvement and utilization review. 
• At least 2 years of case management or homecare experience.
• BSN or Bachelor's degree in related field.
• Additional languages 

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Licensure/Certification Requirements

REQUIRED:

• Current RN license from the NY State Board of Registered Nursing.
• Current CPR certification.

Disclaimer

Qualified applicants will receive consideration for employment without regard to their age, race, religion, national origin, ethnicity, age, gender (including pregnancy, childbirth, et al), sexual orientation, gender identity or expression, protected veteran status, or disability.
Successful candidates might be required to undergo a background verification with an external vendor.

 

Job Details

Req Id 96413 
Department CARE MGMT SVCS 
Shift Days
Shift Hours Worked 8.50
FTE 1 
Work Schedule SALARIED GENERAL
Employee Status A1 - Full-Time 
Union Non-Union
Pay Range $73,000 - $116,00 Annually

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