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Job Title: Quality/Care Management RN
Reports To: Director–Quality Resources
Direct Reports: NoneÂ
FLSA Classification: Non-Exempt
Position Summary
The Quality/Care Management RN is responsible for providing project management, facilitation and support for the development, implementation and evaluation of the Quality Improvement programs and annual Quality Improvement Work Plan. Serves as a clinical resource for utilization review, case management, and discharge planning and provides cross-functional operational support and coverage to ensure continuity of service to support patient needs. Supports accreditation, compliance, and CMS Conditions of Participation related to continuous improvement.
General Duties, Tasks and Responsibilities
- Serves and assists as a clinical resource and mentor for Quality Improvement, Case Management, Utilization Review and Discharge Planning.
- Participates and assists in providing in-service education to appropriate staff and practitioners as needed.Â
- Organizes relevant clinical teams for quality improvement review and implementation.
- Reviews evidenced based literature for identification of "best practice" benchmarks.
- Establishes indicators for monitoring and evaluating quality and appropriateness of care.
- Achieves targeted goals relating to quality and patient safety.
- Helps support and maintain knowledge for Case Management RN, Utilization Review RN, and Discharge Planning.Â
- Assists with regulatory documentation, denial prevention, insurance appeals processes, care coordination, medical necessity reviews, discharge planning assessments and transition of care needs including Swing Bed Program needs.Â
- Provides consultation and education across the organization in the area of Performance Improvement.
- Works with Practitioners and staff on quality improvement initiatives.
- Assists in the development and analysis of quality improvement reports as well as data entry for reported sites compiles and abstracts quality data and provides metric reports as required.
- Performs and participates in chart audits and chart reviews to ensure compliance and improve quality.
- Compiles and abstracts quality data and provides metric reports as required.
- Serves as back-up to Case Management RN, Utilization Review RN, and Discharge Planner.Â
- Complies with all established safety procedures to ensure a safe environment for patients, visitors and staff.
- Participates in performance improvement activities.
- Performs other duties as assigned.
Education Requirements
- Associate’s in nursing RequiredÂ
- Bachelor’s in nursing Preferred
Certification/Licensure Requirements
- Current IL RN License Required
- BLS Required
Experience Requirements
- Case Management and/or Utilization Review experience Preferred
- Performance Improvement activities minimum 1 year Preferred
- Knowledge of CMS Conditions of Participation and regulations PreferredÂ
Computer Skills
- Strong computer skills including Microsoft Word, Excel, PowerPoint and Outlook
- Ability to navigate EMR systemÂ
Additional Skills
- Ability to work independently, prioritize and complete tasks in a timely manner
- Excellent collaboration and interdisciplinary communication skills
- Strong interpersonal, critical thinking, organizational and time management skills
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