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Community Medicine Foundation Quality Nurse in Rock Hill, South Carolina

Summary: Responsible for participating in the quality management efforts including development, implementation, education, data collection, and analysis.iDuties and Responsibilities include the following. Other duties may be assigned.i1. Performs medical charts reviews in the EMR system for compliance with clinical quality measures from various quality programs such as HEDIS and UDS.i2. Locates medical screening results documentation to ensure quality measures are followed in the closure of gaps. Will not conduct any evaluation or interpretation of Clinical data.i3. Conducts patient outreach and assist in closing gap in care, review charts/complete audits and perform data entry to monitor quality initiativesi4. Performs medical records collection and submission for HEDIS season.i5. Monitors utilization and service quality through HEDIS quality measures, payer/provider/patient satisfaction surveys.*i6. Reports audits findings requiring clinical judgment and expertise to the Quality Improvement leader, as assigned.*i7. Helps quality improvement leader to implement, and maintain a comprehensive medical practice continuous quality improvement (CQI) program to include utilization management and risk management.*i8. Assists in educating staff, including physicians, about QI systems and requirements.*i9. Recommend and implement activities to drive quality improvement initiatives and projects as identified based on organizational and department prioritiesi10. Monitors medical practice efforts to ensure compliance with internal and external QI standards.*i11. Promote quality improvement initiatives through use of PDSA cycle.i12. Supports and acts as liaison with payers, providers, and patients and service as a patient information resource for payers, as assigned.*iiSupervisory Responsibilities:NoneiQualifications:To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.iEducation/Experience:Graduate of an approved school/training program for registered nurses or licensed practical nurses required. Minimum of two (2) years of direct patient care in an ambulatory health care setting. Must exhibit knowledge of medical records and analysis of processes of clinical care in addition to exhibiting knowledge of familiarity with the HEDIS/STAR measures and standards. At least two (2) years experience in managed care, or health care regulatory agency environment with a minimum of two (2) years experience in utilization management or quality improvement or chart abstraction for HEDIS/STAR, preferred.iLanguage Ability:Ability to read and comprehend simple instructions, short correspondence, and memos. Ability to write simple correspondence. Ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization.iMath Ability:Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.iReasoning Ability:Ability to apply commonsense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.iCertificates and Licenses:Valid SC license for RN or LPN requiredCPR certification requiredCertified Professional in Healthcare Quality (CPHQ) preferred.iiKnowledge, Skills and Other Abilities:Basic nursing knowledge to include but not limited to preparing patients for physician visit, childhood and adult immunization requirements and routine protocols.iAbility to develop and maintain personable yet professional relationship with patients and staff is required.Knowledg