Clinical Quality RN Specialist, PHO

Cape Cod Healthcare • Contract • Hyannis, MA, US • 1w ago

Serve as a clinical resource for PHO quality department.
Supports CCHN PHO performance efforts by assisting the CCPP PO physician practices to operationalize and succeed in performance and quality initiatives including but not limited to: disease management initiatives and performance improvement related initiatives.
Support case management integration by providing patient level coordination between the PHO and provider practices.
Assist with case management to help fulfill contractual requirements.
Provide clarification and support on performance related reports and accompanying documentation with provider offices.
Develops targeted areas for clinical priority focus and creates action plans for performance activities in conjunction with the case management team.
Meets with physician practices to identify barriers to clinical performance achievement. Gains buy-in from practice for plan implementation.
Performs functions necessary to meet the goals of any action plan implemented by quality team and case management team.
Involves case management team and medical director in physician practice discussions or education where necessary and appropriate.
Provide ongoing support for case management and maintain a reduced case load
Participates in PHO-related committees, education programs, in-services, and meetings as required.
Helps build, improve, and maintain positive relationships with CCHN PHO physicians and practice managers.
Maintains collaborative team relationships with physicians, physician practice staff, PO Managers, CCHN PHO staff and health plans to effectively contribute to the achievement of goals.
Performs other related duties as assigned or requested to meet the scope of the organization’s mission.
Consistently provides service excellence to all patients, family members, visitors, volunteers and co-workers.
Challenges current working practices; identifies process improvement opportunities and presents recommendations and solutions to management. Engages and commits to the organization’s culture of continuous improvement by actively participating, supporting, and promoting CCHC Pillars of Excellence.
Current license as a Registered Nurse in the Commonwealth of Massachusetts. Bachelor of Science Degree in Nursing preferred.
Demonstrates competency with a minimum experience of 3 years in a hospital setting, home health care or outpatient Physician Office setting.
Demonstrate recent knowledge/experience within past 3 to 4 years in: case management or Utilization/quality management.
Ability to speak effectively before individuals and groups of patients or employees of the organization.
Strong interpersonal and negotiation skills demonstrated by a positive attitude, pleasant, professional, and cooperative demeanor, with patients, physicians, fellow employees, and insurance companies.
Excellent organization and time management skills.
Possess skills in independent decision-making, problem-solving, independent judgement, use of critical thinking and effective communications.
Ability to work independently and effectively in a fast-paced environment.
Ability to work productively in a stressful environment and effectively handle multiple projects and changing priorities.
Proficient computer skills with ability to utilize and integrate information from multiple software and EHR systems.
Must demonstrate leadership abilities.

Purpose of Position

Provides education and professional support for all clinical and quality performance initiatives. Supports comprehensive coordination of quality of care services for the PHO team. Provides on-site support for the physician practices to meet organizational quality and efficiency goals with focus on patient engagement and optimization of practice workflow.

Schedule Details

Full Time, Mon-Fri, 8a-4p, No Weekends & No Holidays

Organization

Cape Cod Healthcare, Inc.

Primary Location

Massachusetts-Hyannis

Department

HCI-PO - PHO

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