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REGISTERED NURSE- QUALITY CARE MANAGER

Position: Quality Care Manager - RN

Department: Quality Management

Reports to: Director/Designated Manager

Created: 4/10/25

Job Summary

Through the Quality Care Management department, the Quality Care Manager supports clinical workflow that integrates value-based performance criteria. The position collaborates with patients, families, providers, other caregivers and disciplines to create a structure of managed care for complex patients. Quality Care Managers help improve quality, promote safe clinical care, guide appropriate use of resources, and enhance the patient and family's healthcare experience. This position supports the care delivery team and demonstrates teamwork within the Care Management department and across other departments.

Essential Duties and Responsibilities

+ Efficient use of electronic medical records, word documents, and spreadsheet computer programs. Knowledge of clinical workflow, case management, health care revenue cycle or population health management is preferred. Experience with data collection and analysis preferred

+ Professional Responsibilities:

+ Consistently applies established care management principles

+ Responsible for coordinating quality care management on assigned medically complex patients

+ Collaborates with the attending physician to establish a working DRG and expected LOS

+ Identifies and guides appropriate clinical resource utilization and helps coordinate patient referrals

+ Assesses discharge needs and coordinates discharge plans to meet patient and family needs

+ Assess readmission risk and implement a plan to reduce unplanned hospital readmissions

+ Supports clinical workflow for compliance with value-based performance metrics

+ Self-directed and able to take initiative and display the ability to think independently and creative

+ Seeks continual knowledge development of UR, coding quality measures, payors and payment models

+ Knowledgeable of criteria for Medicare, Medicaid, HMO, and private insurance coverage

+ Responsible for evaluating and screening potential admissions to the facility

+ Maintain proficiency in-use of evidence-based/criteria guidelines InterQual

+ Educate physicians and nurse practitioners regarding the appropriate level of care/utilization issues

+ Work collaboratively with patients, families, and physicians to ensure high quality care, cost-effective care

+ Provide initial discharge planning assessment for both inpatient and observation patients admitted through the ED

+ Work collaboratively with the inpatient care manager and the utilization review department to support transitions from ED to inpatient

+ Work with leadership to ensure targets are met for the operating/financial management

+ Participates as an effective team member with other Care Managers, Social Workers, and clinical caregivers

+ Supports physician workflow to integrate quality, customer satisfaction and efficiency metrics

+ Demonstrates secure and confidential access to protected health information

+ Completed training and educational assignments by deadlines

+ Coordinates effective transition of inpatients to post-discharge care providers

+ Apply regulatory standards within the department

+ Demonstrate a compassionate and caring approach towards patients and their family

+ Establish collaborative working relationships with others-contribute to department improvement activities and department decisions

+ Assist with data collection, monitoring and responding to outcome metrics for the assigned patient population

+ Core Duties:

+ Adhere to all SCRMC policy and procedure and employee performance standards

+ Demonstrates reliability by consistently reporting to work on time as scheduled

+ Contribute to effective use of salary and other department resources

+ Assess safety risk and risk of hospital acquired conditions and mitigates risk in mitigate patient population

+ Participates in department improvement and other activities

+ Demonstrates competency in performance of relevant clinical skills

Qualifications Education and Experience

+ Current RN license by the Mississippi Board of Nursing

+ Minimum of three years of acute care clinical experience

+ Must be able to read, write, understand verbal and written communication

Preferred Qualifications

+ CPR or ACLS Certification

Minimum Requirements Essential Skill Competencies: Interaction Skills

Effectively communicate- verbal and written; negotiation; conflict resolution; interdisciplinary collaboration; customer service attitude; ability to provide instructions and education

Other Essential Skill Competencies

+ Apply care management principles

+ CPR certification-safe workflow processes

+ Infection prevention

+ Local post-acute care services knowledge

+ Flexible and adaptable to changing priorities

+ Safe patient care delivery processes

+ EMR and use of other electronic software

+ Creative problem solving-critical/ analytical thinking

+ Data interpretation, meaningful analysis

Working Conditions

Frequently Continuously Sit, Walk, Seeing (Visual), Stand, Reach, Listening, Lift, Carry, Simple Grasping, Squat, Distinguishing colors, Bend Body, Fluids, Kneel, Firm Grasping, Climbing Stairs, Forearm Rotation, Hazardous Materials, Lifting up to 10lbs, Lifting 10-50lbs, Carrying Up to 10lbs, Lifting > 50lbs with assistance, Push on wheels Up to 200lbs, Carrying 10 to 20lbs, Use of Wheelchair, Push on wheels 200-400lbs, Use of Stretcher, Pulling Up to 350lbs with assistance Use of Carts, Use of Computer Exposure

Classifications: High exposure risk