Clinical Quality of Care Coordinator

Location Address:

9521 San Mateo NE
Albuquerque, NM 87113-2237


Compensation Pay Range:

Minimum Offer $60,985.60
Maximum Offer $103,812.80
Now Hiring: Clinical Quality of Care Coordinator

Summary:

Responsible for Quality of Clinical Care activities. Coordinates the process. Investigates all complaints alleging inappropriate clinical care or alleged inappropriate behavior by a physician. Applies the knowledge of a registered nurse to determine the key factors in each case, documenting findings for all parties regarding investigative findings. Collaborates with other staff including Patient Safety, Patient Relations, Risk Management, Legal, Quality, Compliance, Clinical Operations, and Medical Staff

Type of Opportunity: Full time
Job Exempt: Yes
Job is based: Reverend Hugh Cooper Administrative Center
Work Shift: Days (United States of America)


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. Supports implementation of change projects/initiatives.
• 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.
• Prepares response letters and communications related to patient and family grievances, complaints, and quality concerns.
• Ensures timely completion and submission of responses in accordance with established requirements and deadlines
• Provides appropriate referrals to Legal/Risk Management for potential legal or at risk issues
• Manages the quality of care database for occurrence screening, quality of care reporting, and to monitor and evaluate issues as a network. Uses the data to drive decisions and plan/implement performance improvement strategies.
• Develops training materials to address complaint and grievance improvement opportunities and collaborates with other 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. Participates on process improvement teams as appropriate.
• Performs other functions as required, i.e. cross-training to support reporting for regulatory agencies, accrediting organizations, public and private payors, and other external entities; clinical quality projects.

Qualifications:

• Current New Mexico RN License required.
• Bachelors degree required
• Three to five years experience in clinical nursing field required, three years quality improvement experience preferred.
• Three years case management or care coordination experience preferred.
• Excellent written and oral skills required.
• Skills in Word, Excel, and Power Point necessary..
• Demonstrates ability to work with highly sensitive and confidential information.
• Ability to learn complaints and grievance database system preferred. Demonstrates ability to work with highly sensitive and confidential information

All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.

Wellness
Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.

Why work at Presbyterian?
As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.

About Presbyterian Healthcare Services
Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.

We're Determined to Support New Mexico's Well-Being | Presbyterian Healthcare Services