Clinical Quality Nurse

The Clinical Operations Manager & PCMH Manager ensures that clinical procedures follow internal policies, clinical protocols, and regulatory requirements for patient safety. In conjunction with Chief Operating Officer and the Chief Medical Officer (or their designees), this position plans, directs, and evaluates improvement and quality assurance activities within the organization with the goal of boosting cost effectiveness and efficient performance while delivering high-quality patient care. The Clinical Quality & PCMH Nurse Manager coordinates operational components with the objective of increasing consistency across the organization; improving patient outcomes; improving patient, provider, and staff satisfaction; managing risk and reducing cost and quality variability.

KEY ACCOUNTABILITIES

Quality Management

• Facilitates the delivery of high-quality patient care.
• Develops and analyzes reporting to manage quality metrics and address areas of improvement required.

• Coordinates clinical quality activities daily including working with the Medical Directors and Senior Clinical Operations Manager to implement and revise QI/QA workflows and procedures, complete QI/QA assessments, and monitor QI outcomes.

• Regularly reviews quality and accuracy of clinical data and services provided by clinical support staff to meet organizational goals and reporting requirements.
• Oversees preparation of weekly scorecard of the organization’s weekly productivity
• Leads the Quality Committee to monitor and develop continuous Quality Improvement processes and assures that quality assurance criteria are met.
• Partners with the senior staff to support PCMH and clinical program initiatives to satisfy program requirements and achieve and maintain standards required for certifications.

• Supervises Quality Assistant positions, including coordination of Quality Committee meetings and preparation of QC meeting minutes; and other duties as assigned.
• Collaborates with IT in system upgrades.
• Collaborates with Data Specialist in developing Quality reporting.
• Updates e-scribe console and performs clinical updates within Centricity.
• Continuously monitors the use of the electronic health record system as it relates to quality workflows and provides onsite assistance to staff.

• Collaborates with the Medical Director—Clinical Services on maintaining status of Patient-Centered Medical Home (PCMH) designation.
• Participates in special projects, including, but not limited to: FTCA application processing, UDS data collection, Promoting Interoperability, and clinical 330 data.

Patient Center Medical Home

• Ensures on-going compliance with PCMH requirements to maintain PCMH certification.
• Works in conjunction with operations staff to develop, improve and monitor clinical workflows as needed to maintain PCMH compliance.

• Effectively manage and complete special projects in support of PCMH clinical operations.

• Implement processes and programs with emphasis on quality management and patient centered care.

• Complete audits as required by the PCMH Quality Improvement Plan, grants, or other policies.

• Develop and provide routine reports for presentations, dashboards, and operational improvement activities for PCMH program.
• Perform onsite reviews regarding quality issues by creating PDSA’s and utilizing other quality tools.

Research

• Coordinate clinical research projects as they become available.

Clinical Policies & Procedures

• With the Executive and Managerial staff, participates in the strategic development, administration, evaluation and updating of all clinical policies and procedures.
• In conjunction with the Associate Medical Directors, plans, directs, and evaluates clinical activities within the organization, particularly as it relates to Clinical Support staff processes and training. Drafts and review clinical policies and procedures.

Patient Satisfaction

• Determines process for measuring Patient Satisfaction and implements those processes, as well as continually assesses and updates those processes.
• Monitors patient satisfaction data and develops strategies to ensure target levels are attained and maintained.

EDUCATION/EXPERIENCE

• Two (2) + years of progressively responsible clinical and quality operations experience.
• Equivalent combination of experience/education.
• IL RN License

KNOWLEDGE, SKILLS & ABILITIES

Knowledge:

• Thorough understanding of the healthcare environment including an understanding of HRSA FQHC requirements as they relate to FCHC’s provision of services to the community, as well as regulatory compliance i.e., HIPAA, OSHA, etc.
• Thorough understanding of the PCMH program and requirements.
• Extensive knowledge of practice management and EMR technology.
• Thorough knowledge of primary care practice and risk management.
• Knowledge of effective training practices and learning system delivery.
• Knowledge and training on PCMH requirements.
• General knowledge of all aspects of the revenue cycle.
• Knowledge of regulatory compliance i.e., HIPAA, OSHA, etc.

Skills:

• Skill in exercising a high degree of initiative, judgment, discretion, and decision-making.
• Skill in establishing and maintaining effective working relationships with management, colleagues, subordinates, patients, and the public.
• Skill in organizing work, delegating, and achieving goals and objectives.
• Excellent interpersonal skills and empathy towards patients, as well as strong communication skills, critical thinking skills, the ability to handle stressful situations, the capacity to function independently and the ability to document meticulously.
• Must have excellent process improvement skills and ability to understand clinic functions and department interactions.

Abilities:

• Ability to create and interpret reports from the practice management system.
• Ability to identify and implement opportunities for process improvement and implementation.
• Ability to identify trends and motivate workforce toward changes needed to adapt and remain competitive.
• Ability to manage and supervise various positions and relate well to people from diverse ethnic and cultural backgrounds, as well as have a passion for working with at-risk, culturally diverse populations.
• Ability to read, understand and interpret budgets, spreadsheets, and legal documents.
• Ability to hold subordinates accountable for organizational goals.
• Ability to make difficult decisions.
• Willingness to work flexible hours to meet the organization’s needs/demands.

PHYSICAL REQUIREMENTS

• Seeing: Must be able to read head written and printed material, as well as use computer, fax machine, Xerox machine and other medical equipment in accordance with specialty.
• Hearing: Must be able to hear well enough to communicate with coworkers and others. Good hearing is necessary to receive detailed information through oral communication and to make fine discriminations in sound.
• Sitting: Must be able to sit for much of the work shift while answering the telephone and communicating with others.
• Standing/Walking/Mobility: Must be able to stand intermittently and be capable of walking on hardwood and linoleum floors with concrete underpayments. Must be able to walk between various clinical areas and departments.
• Fingering/Grasping/Feeling: This position requires manual and finger dexterity and eye-hand coordination for easy and skillful use of hands when working with and performing normal office duties and responsibilities.

WORK ENVIRONMENT

• Fast paced work environment.
• The noise level in the work environment is usually moderate.