Premier Community Healthcare
  • 11-Jun-2021 to Until Filled (EST)
  • Nursing
  • Dade City, FL, USA
  • Full Time

Excellent Benefits


Quality Care Service RN

General Description:

Under the direction of the Quality Care Services (QCS) Manager, the Quality Care Services (QCS) Nurse assesses, plans and coordinates all aspects of medical and supporting services across the continuum of care for assigned members to promote quality and cost-effective care, through the ongoing support of individual patient needs. The QCS Nurse provides the medical care team with patient utilization information, evaluate and addresses potential care gaps.

Knowledge, Skills and Abilities:

  • Strong oral and written communication skills
  • Ability to effectively navigate and enter data into an EHR; Strong Microsoft Office Suite skills, specifically Word, Excel, and ability to utilize data analytics programs
  • Excellent interpersonal skills and ability to develop and maintain effective working relationships with patients and coworkers
  • Highly organized, with excellent attention to detail and problem-solving skills
  • Ability to communicate effectively with patients and care team, while maintaining a professional demeanor
  • A self-motivated, independent, highly driven and results focused individual

Essential Duties and Responsibilities:

  • Assess the level of need of individuals/families assigned for QCS management services including individuals with medically complex needs, chronic illnesses and intellectually challenged individuals
  • Conduct detailed analysis for the assigned patients to identify possible gaps in care and determine necessity of medical or non-medical interventions based on nursing knowledge, PCHG policies and procedures, and third-party payors guidelines
  • Provide ongoing outreach to a caseload of identified PCHG patients. Communicate with patients to encourage healthy behaviors and ensure patients are well informed and empowered to make proactive decisions about their own care and provide necessary education
  • Provides targeting coaching and education to care team members and providers as needed
  • Keep accurate records of caseloads and ensures that any required measures are completed and reported in a timely manner
  • Complete all documentation within 24hrs as per agency standard including case records, and case notes, and outcome measures
  • Meet regularly with QCS Manager to review cases and job performance
  • Collaborate with PCHG providers and clinical teams.
  • Schedule and maintain appointments with providers and clinics to provide education related to reviews
  • Perform plan-specific activities as required (Health Risk Assessments, Annual Wellness Outreach, etc.)
  • Maintain confidentiality within the workplace with all written and verbal communications pertaining to, staff, and community operations. Strict adherence to all State, federal, HIPAA, PCHG and accreditation agency rules and regulations
  • Ability to leverage best practices using advanced analytics models, and data driven strategies to improve and optimize patient outcomes.
  • Knowledgeable of HEDlS and the use of HEDIS gap reports/Meaningful Use reports/data reports in relationship to clinical visits/billing and some coding knowledge
  • Other duties as assigned

Registered Nursing Specialized Skills- Patient Care Treatment Planning - Planning Case Management- Patient Direction - Family Education and Instruction Clinical Experience-Acute Care -Safety - Process Improvement - Critical Care Pediatrics Medication Administration Care Plans Screening- Nurse Management Advocacy- HIPAA- Appointment- Data Entry- Immunizations- Trauma- Patient Flow- Caregiving- Triage-Computer EMR-HER Electronic Medical Records- Heath- Trust Respect Integrity Compassion - Excellence- Community Health- Office- Front Desk- Doctors office- Health center- Infection Vitals- Injection - Office Equipment - Risk Management -First Aid -Procedure Wounds - Patient Preparation Meditech Greenway -Intergy -Dentrix -Dexces Phreesa Grants - Family Medicine, Pediatrics, Women Services, Dental, Behavioral Health problem resolution

Full Job Description
Premier Community Healthcare
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