Quality Management LVN

The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health’s Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups hospitals health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first.

Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art flexible Health & Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options including medical dental and vision plans for the employee and their dependents Health Spending Account (HSA) Life Insurance and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave.

*This position will be mainly work from home, with travel to physician offices within the North State and Stockton, CA regions.

Position Summary:

The QM Nurse provides local Chapter support to the CI Program through continuous interaction and education with the participating physicians and hospital QM staff. The QM Nurse reports to the Director and is an employee of Dignity Health Management Services Organization.
The QM Nurse provides support to the Clinically Integrated (CI) Program through continuous interaction and education with the participating physicians and mid-levels providers, as well as statewide hospital and CIN QM staff. This position requires a dynamic and highly motivated person with the ability to inspire and lead people, as well as communicate effectively with employees, Physicians, other Management Service Organization Administrators and staff and Hospital staff.

Responsibilities may include:
- Serve as a key interface and liaison for the local participating physicians through collaboration with the Executive Director, Physician Practice Liaison, and local hospital Quality Management Staff and other key members of the CIN leadership team.
- Responsible for physician education and training on processes and workflow related to clinical initiatives undertaken as a part of the CI Program, including CPTII and HCPCS coding, documenting quality data in paper and electronic charts, and reporting via the dashboard. This may require travel to provide on-site training in physician offices.
- Working closely with Physician Practice Liaison to provide physician office staff education regarding support for physician in implementing clinical initiatives undertaken within the physician’s area of specialty.
- Collaborate with physician practice liaison on data integrity.
- Provide one-on-one education on use of dashboard reports and other communications as appropriate to identify potential improvements and assist physicians in understanding methods and processes required to achieve measurable results.
- Collaborate with the Quality Director, Executive Director, and Medical Director in preparing analyses, as well as monitoring, interpreting, and educating on results of clinical (ambulatory and hospital) quality, cost and utilization data.
- Responsible for monitoring and evaluating physician compliance and performance with quality standards, as identified in weekly, monthly and quarterly reports and provide feedback to the Quality Director, Executive Director and Medical Director.
- Perform patient chart review to reconcile quality reporting results with chart documentation.
- Provide Executive Director, Medical Director and Quality Director with support on performance improvement and development of remediation plans at the local service area Chapter level.
- Support marketing and communications with materials relating to disease management programs.
- Attend local quality management committee meetings, if requested by the Executive Director, Medical Director or Quality Director.

Minimum Qualifications:

- Minimum 6 months or longer in an Ambulatory and/or clinic setting as an LVN.
- Must possess a keen working knowledge of Medical Management process improvement activities (QM Programs, Pay-for-Performance measures), including analysis of qualitative and quantitative clinical data concerning patient outcomes, to ensure the highest quality care is documented consistent with the CI Program guidelines.
- Experience navigating through patient information in an Electronic Medical Record (EMR) application in the ambulatory setting.
- Degree from college or university nursing program.
- Clear and current CA LVN license.

Preferred Qualifications:

- 2 years’ experience in a quality management program in a managed care/health plan, IPA, hospital setting(s).