Clinical Quality of Care Coordinator - Performance Management
US-NM-Albuquerque
Careers (External)
Req #: 45105
Type: Full Time
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Overview: Now hiring a Clinical Quality of Care Coordinator! Presbyterian is seekign a Clinical Quality of Care Coordinator that is responsible for Quality of Clinical Care activities. Coordinates the provider peer review process which assesses and reviews the quality of patient and member care provided by direct care providers and facilities. Investigates all complaints alleging inappropriate clinical care or alleged inappropriate behavior by a physician or other health care practitioner/provider. Applies the knowledge of a registered nurse to determine the key factors in each case and whether the standard of care has been met, documenting and summarizing findings for all parties regarding investigative findings. Collaborates with other staff including medical directors, registered nurses, and legal counsel. How you belong matters here. We value our employees' differences and find strength in the diversity of our team and community. At Presbyterian, it's not just what we do that matters. It's how we do it - and it starts with our incredible team. From Information Technology to Food Services and beyond, our non-clinical employees make a meaningful impact on the healthcare provided to our patients and members. Why Join Us * Full Time - Exempt: Yes * Job is based Rev Hugh Cooper * Work hours: Days * Benefits: We offer a wide range of benefits including medical, wellness program, vision, dental, paid time off, retirement and more for FT employees. Ideal Candidate: Current New Mexico RN License required. Bachelors degree required, BSN preferred. Three (3) to five (5) years experience in clinical nursing field required, three years quality improvement experience preferred. Responsibilities: * Coordinates tracking and trending of data for QOC, reporting to appropriate internal committees and bodies as well as external agencies. * Collaborates closely with internal stakeholders. * Develops and refines processes, policies and procedures, and desktop tools. * Reviews, responds to, and researches complaints related to quality of medical care utilizing a high level of knowledge and skill in nursing practice in order to discern the key factors in each case to ensure that all quality of care issues are identified and addressed. * Presents the facts of the case and makes recommendations to the Peer Review Committee for cases involving quality of care issues. * Develops and maintains a formalized process for sharing of quality of care practitioner information at an enterprise level working with legal, credentialing, medical staff affairs, provider network management, and the medical group. * Develops and maintains process for internal and external peer review in consultation with legal. * Manages the quality of care database for occurrence screening, quality of care reporting, and to monitor and evaluate issues as a network. * Develops training materials to address individual and network-wide improvement opportunities and collaborates with Provider Services staff to develop and implement the approach that will be most effective in influencing practice. * Advises leadership in the identification of system processes that could be improved to maximize patient safety, optimize positive patient outcomes, and minimize financial loss. * Performs other functions as required, i.e. cross-training with Critical Incidents, clinical quality projects. Qualifications: * Current New Mexico RN License required. * Bachelors degree required, BSN preferred. * Three (3) to five (5) years experience in clinical nursing field required, three years quality improvement experience preferred. * Three years case management or care coordination experience preferred. * Excellent written, oral, and facilitation skills required. * Skills in Word, Excel, and Power Point necessary. * Demonstrates ability to work with highly sensitive and confidential information.
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