Job Information
Dignity Health Quality Management RN in Redding, California
Overview
The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health’s Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups hospitals health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first.
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
*This position will be mainly work from home, with travel to physician offices within the North State and Stockton, CA regions.
Position Summary:
The Quality Management Nurse provides service area support to the Clinically Integrated Networks (CINs) across California. The QM Nurse reports to the Director and is an employee of Dignity Health Managed Services Organization.
The QM Nurse provides support to the Clinically Integrated (CI) Program through continuous interaction and education with the participating physicians and mid-level providers, as well as statewide hospital and CIN QM staff. 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.
Responsibilities may include:
Serve as a key interface and liaison for the participating physicians through collaboration with the Executive Directors, physician practice liaisons, QM Nurses, and other key members of the CIN leadership teams.
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 may require travel to provide on-site training in physician offices.
Working closely with Physician Practice Liaisons 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 Liaisons and QM Nurses by developing proficiency in understanding quality data extracts and reporting.
Collaborate with the Physician Practice Liaisons and QM Nurses 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 Director, CIN Executive Directors and Chief Medical Officers (CMO)/Medical Directors 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 Director and CIN Executive Directors.
Perform patient chart review to reconcile quality reporting results with chart documentation, using a sampling methodology approved by the CIN Board of Managers.
Provide Executive Directors with support on performance improvement and development of remediation plans at the local service area level.
Support CA CIN marketing and communications with materials relating to disease management programs.
Attend local quality management committee meetings, if requested.
Qualifications
Minimum 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.
Degree from college or university nursing program.
Clear and current CA Registered Nurse (RN) license.
Pay Range
$42.69 - $61.91 /hour
We are an equal opportunity/affirmative action employer.