Clinical Quality Nurse – RN

Join US. We work every day to improve health outcomes by supporting our Primary Care Physicians (PCPs). Finding new and innovative ways to deliver healthcare requires an inspired team of bright, hard-working individuals. If you think you have what it takes to make a difference, then take a look at our Clinical Quality Nurse position.

The Clinical Quality Nurse will initiate, actively manage, and execute initiatives aimed at driving performance in Tandigm’s quality on HEDIS and Stars quality metrics. These initiatives may be both internal at Tandigm or external involving our PCP and Specialist network. This position will provide clinical support, training, and engagement in conjunction with the Population Health Services Organization team, Care Team, Tandigm Care Solutions, Accurate Coding and Education team and other departments as needed.

Essential Functions

  • Manage activities to drive performance across several key quality metrics.
  • Provide clinical expertise for all HEDIS related projects and interventions initiated by the Quality Team.
  • Collaborate with Tandigm Care Team to provide outreach and support to patients with difficulty adhering to their medications, including ways to address patient barriers to adherence.
  • Develop content and resources related to diabetes education to be shared with Tandigm Care Team.
  • Contribute to the development of effective patient and provider-facing education and communication materials.
  • When appropriate, travel to patients’ homes to provide screenings such as bone density scans or retinal eye screening.
  • Manage performance related to rheumatoid arthritis measure though outreach to PCP and specialist offices as well as patient education.
  • Support awareness month campaigns, including by organizing call campaigns for patients in need of screenings.
  • Work with provider offices to obtain medical records and reports based missing quality metrics, perform clinical and non-clinical chart reviews, ensure data entered into quality tool.
  • Monitor accuracy of abstracted records as required by HEDIS specifications
  • Participate in in ongoing discussions concerning data collection, methodology, and data analysis for HEDIS and Star Measure projects.
  • Understand HEDIS and Stars measures based on NCQA and CMS standards.
  • Educate practices as needed on documentation requirements for certain HEDIS measures.
  • Working with Accurate Coding and Education team, ensure that appropriate diagnoses indicative of compliance or exclusions are captured.
  • Assist in preparing and implementing training for Clinical and Non-Clinical staff regarding HEDIS & Stars.
  • Appropriately engage the Compliance Department to ensure that programs maintain Tandigm’s compliance with federal, state, and/or local regulators and laws, and are within Tandigm’s contracted obligations to all stakeholders.
  • Consistently exhibit behavior and communication skills that demonstrate Tandigm’s commitment to superior customer service, including quality, care and concern with each and every internal and external customer.
  • Use, protect, and disclose Tandigm’s patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
  • Communicate internally and externally as needed to gather necessary data.
  • Attend to provider calls in accordance with exceptional customer service.
  • Promote a positive working relationships.
  • Perform duties in professional manner, utilizing time and resources efficiently.
  • Perform other duties, projects and actions as assigned.

Education

BSN required; MSN preferred; with

Licenses/Certifications

  • Valid U.S. State Driver’s License as well as proof of liability and property damage insurance on any vehicle used for business purposes.
  • Current PA Nursing License (RN) in good standing

Experience

Minimum

  • 5 years in quality improvement or clinical care aimed at improving patient outcomes.

Preferred

  •  Experience with diabetes education/management preferred.
  •  Familiarity with electronic medical record systems preferred.
  •  Experience with managing programs preferred.
  •  Working knowledge of MS Office Suite (Excel, Word, PowerPoint); proficiency preferred

Essential Knowledge, Skills and Abilities

  • Must embrace and exemplify the core vision and values of Tandigm Health.
  • Working knowledge of the NCQA and CMS quality measures.
  • Creativity and can-do attitude required to launch new initiatives.
  • Ability to work independently on projects.
  • Customer-service oriented; responsive and respectful to colleagues, clients, patients, and providers.
  • Strong communication skills to work with both patients and provider offices.
  • Ability and availability to travel independently to sites within the five county Philadelphia region, on a flexible schedule, as required.
  • Proficient in MS Office Suite (Excel, Word, PowerPoint, Access).

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