Company Description

Job Description

The Registered Nurse - Quality of Care main function is to manage internal quality of care referrals and support other quality efforts under Clinical Services and CareOregon Quality Health Outcomes quality initiatives.

Requirements

Experience and/or Education Required Minimum 3 years’ experience as an RN in the healthcare industry Current unrestricted license as a registered nurse in the State of Oregon Preferred Bachelor’s degree in Nursing Prior primary care and/or specialty clinic practice experience RN experience with quality improvement, population health and/or case management Knowledge, Skills and Abilities Required Knowledge Knowledge of or desire to learn about current clinical practices specifically issues related to quality of care for our members Skills and Abilities Ability to efficiently glean clinical information from a medical record, or other specialized software, and save supporting documentation in appropriate data management toolok, Critical thinking skills Strong attention to detail Competency with computers and software programs, e.g. PDF, MS Outlook, Word, Excel,EMR, systems Ability to learn and adapt to new EMR systems, software programs, specification changes and deadlines Ability to maintain strict confidentiality of protected health information Awareness of the social determinants of health impacting CareOregon members and approaching interactions with clinics, members or CareOregon embedded staff with kindness and friendliness Ability to work in an environment with diverse individuals and groups Have a high degree of initiative and motivation along with ability to effectively collaborate and plan with co-workers and others Ability to manage multiple tasks and flexibility to switch tasks as needed Act professionally at all times when representing CareOregon Ability to work under pressure and help the team meet deadlines for regulatory deliverables Good written and verbal communication skills Excellent customer service skills and ability to work across multiple departments Ability to prioritize work in a remote environment Ability to work effectively with diverse individuals and groups Ability to learn, focus, understand, and evaluate information and determine appropriate actions Ability to accept direction and feedback, as well as tolerate and manage stress Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day Ability to hear and speak clearly for at least 3-6 hours/day Ability to lift, carry, push, pull and/or pinch small objects for at least 1-3 hours/day Working Conditions Work Environment(s): ☒ Indoor/Office ☐ Community ☐ Facilities/Security ☐ Outdoor Exposure Member/Patient Facing: ☒ No ☐ Telephonic ☐ In Person Hazards: May include, but not limited to, physical and ergonomic hazards Equipment: General office equipment Travel: May include occasional required or optional travel outside of the workplace; the employee’s personal vehicle, local transit or other means of transportation may be used. Work Location: Hybrid-Office 1-2 days/month #LI-Remote

Responsibilities

Complete Quality of Care reviews. Work closely with the director of Quality of Care to ensure quality and clinical issues are addressed in a timely and thorough manner. Maintain accurate and complete documentation for files related to quality of care. Utilize enterprise tools such as QNXT, Sharepoint and smartsheets to aid in quality monitoring. Coordinate and facilitate risk reduction strategies for quality and patient safety issues when opportunities are identified. Collaborate with other departments in ensuring quality of care process is working effectively. Conduct annual and other trainings as needed Coordinate and facilitate risk reduction strategies for quality and patient safety issues when opportunities are identified. Take lead in the implementation and ongoing administration of health improvement programs and provide ongoing feedback to Quality of Care director and others as appropriate. Identify education/ training programs for network providers, members, other health care workers and CareOregon staff in support of appeals and grievance process. Develop and monitor a tracking system to ensure accuracy of data, tracking and trending of providers with quality of care issues and other possible data sources related to clinical quality. Provide clinical expertise to other department members, in evaluation of program outcomes, providing input for program activities. Ability to apply CMS, OAR, Contract Requirements and other regulatory standards when performing work. Apply the Equity First approach when conducting work and participate in helping to develop and implement the Equity First approach. Participate in committees such as credentialing, peer review and quality oversight as needed. Organizational Responsibilities Perform work in alignment with the organization’s mission, vision and values. Support the organization’s commitment to equity, diversity and inclusion by fostering a culture of open mindedness, cultural awareness, compassion and respect for all individuals. Strive to meet annual business goals in support of the organization’s strategic goals. Adhere to the organization’s policies, procedures and other relevant compliance needs.

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