The Clinical Quality & Training RN will serve as the clinical resource responsible for the daily implementation of quality assurance and quality improvement initiatives for the Care Management department. This position will also be responsible for conducting training for care management staff to include initial orientation and ongoing re-training to support the achievement of an organizational culture designed to deliver exceptional outcomes to both clients and member populations.
1. Assists and coordinates the development, implementation, maintenance, and revision of the quality and training program(s) for the Care Management department.
2. Assists and coordinates policy and procedure formulation, dissemination, and revisions related to the quality management and training program.
3. Conducts continuous environmental scans for the purpose of identifying improvement opportunities.
4. Performs chart and call reviews for quality assurance.
5. Integrates, performs and oversees results from audits, surveys, feedback, etc. to develop and implement improvement projects.
6. Provides coaching (as needed and per program structure) to clinical & non- staff in order to enhance outcomes.
7. Assists and coordinates the orientation and training process for new employee onboarding and ongoing training.
8. Maintains knowledge of industry trends in measuring and improving quality outcomes.
9. Serves as a liaison between all departments, using advanced communication and interpersonal skills.
10. Facilitates quality standardization & measurements calibration sessions.
11. Partners with internal teams (ex. IT, operations, etc.) to implement initiatives to improve overall program quality.
12. Analyzes care management workflows to identify areas for process improvement.
13. Collaborates with management team to present quality improvement initiatives to both internal and external leadership groups.
14. Partners with the Advance Health Care Management team to quickly respond to urgent issues.
15. Actively participates in new program implementations.
16. Assumes other duties as assigned.
1. RN; Bachelor’s Degree in Nursing, preferred
2. Ability to obtain unrestricted licensure in required states, required
3. CCM and CPHQ certifications, preferred
4. Minimum of five years clinical experience, including telephonic care management experience, required
5. Minimum of 2 years clinical experience in chronic disease management and working with culturally diverse and vulnerable populations to include pediatric, adult and geriatric
6. Robust quality improvement background including working knowledge of benchmarking, process improvement techniques and statistical analysis
7. Minimum of 1 year of experience in gathering, interpreting and reporting data analytics
8. Strong training experience, in-person as well as remote training
9. Managed Care, Transitional Care or Case Management experience, preferred
10. Knowledge of clinical and administrative policies and procedures
11. Knowledge of medical terminology and insurance practices
12. Knowledge of grammar, spelling, and punctuation to type, review and edit reports, documentation and correspondence
13. Knowledge of CPT and ICD-10 coding and documentation
14. Knowledge of customer service skills, patient satisfaction elements and healthcare quality metrics
15. Highly proficient in computer and software application skills
a. Microsoft Office Suite (Word, Excel, PowerPoint, One Note, etc.)
b. Minimum of 1 year of experience with Care Management documentation systems and/or EMR’s.
c. Minimum of 1 year of experience with communication tools (ex. skype, contact center software)
d. Typing proficiency with minimum of 45 wpm
16. Skilled in operating basic office equipment such as copiers and fax machines
17. Skill in handling electronic paperwork/filing adequately
18. Skill in handling incoming phone calls and emails and triaging appropriately
19. Ability to work effectively as a team member in a multi-disciplinary team
20. Ability to interpret and understand insurance benefits and reimbursement
21. Ability to organize and prioritize tasks effectively
22. Ability to work with minimal direction or supervision
23. Ability to demonstrate strong communication skills, including written and verbal
24. Manual dexterity for office machines
25. Sitting for extended periods of time
26. Use of laptops and monitors to conduct QA activities and document findings
27. Use of dialer software to listen to calls for QA activities
28. Position based in the Richmond office with occasional travel to conduct staff training or shadow team members during home visits (valid driver’s license and proof of insurance required)
29. Involves frequent contact with clinical, non-clinical and administrative staff utilizing a collaborative and team-oriented approach
30. Requires ability to manage to tight deadlines and quality standards in a fast-paced environment
Advance Health is an Equal Opportunity Employer