FHW Quality Nurse

3 weeks ago

Amherst NY United States Fallon Community Health Plan Full time

Overview

About us:

Fallon Health Weinberg is a partnership between Fallon Health of Massachusetts and Weinberg Campus of Erie County, New York. Fallon Health Weinberg offers a Program of All Inclusive Care for the Elderly (PACE) and a Managed Long Term Care (MLTC) plan to serve the health needs of dual-eligible residents of the Western New York counties of Erie and Niagara.

Fallon Health is a company that cares. We prioritize our members--always-making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, we deliver equitable, high-quality coordinated care and are continually rated among the nation's top health plans for member experience, service, and clinical quality. Weinberg Campus has been providing needed services to the elderly for more than 100 years, through both community-based programs and nursing facility care. It is a renowned geriatric education and training institution offering the widest range of housing and care options available on one campus.

At Fallon Health Weinberg, we believe our individual differences, life experiences, knowledge, self-expression and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio-economic status and other characteristics that make people unique.

Brief summary of purpose

Is responsible for oversight of quality activities of the Fallon Health Weinberg PACE Program. Provides clinical expertise and technical support for quality initiatives. Reviews the PACE program adherence to CMS and New York State regulations and works to optimize quality of care within the PACE program.

Responsibilities

Primary Job Responsibilities

* In collaboration with the Medical Director and the PACE Program Director, develops and implements the annual Quality Improvement Program.
* Schedules and coordinates quality committee meetings and subcommittee meetings, prepares meeting agendas; records meeting minutes; development, implementation, and updating of individual initiative work plans.
* Coordinates collection of data, analysis and reporting of clinical quality projects and quality initiatives.    
* Participates in CMS PACE audit and is prepared to provide information related compliance oversight and quality improvement programs. Maintains necessary documentation.
* Oversees the PACE program's infection control program.
* Monitors and maintains databases as listed in the FHW quality work plan, annual and monthly satisfaction surveys, grievances, incident reports and active infection reports.
* In collaboration with the PACE Director and Medical Director, ensures compliance with all regulatory and contractual requirements of CMS and NYS.
* Responsible for the annual New York State performance improvement plan (NYS PIP).
* Responsible for HPMS quarterly reporting, NYSDOH data submission, and root cause analysis reports through HPMS.
* Responsible for Quality data quarterly report to FHW Board of Directors and corporate performance line presentations.
* FHW Safety committee member.
* Other duties as necessary

Qualifications

Education

Degree in nursing, Bachelor of Science in Nursingpreferred  

License/Certifications

RN Licensed in NY State

Experience:

* Minimum of 3 years related experience in a healthcare setting preferably with older adult population.
* Experience with regulatory readiness or quality improvement preferred.
* Competence in medical record review and data extraction.
* Strong project

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