Clinical Quality Program Manager – RN

Job Title:                              Clinical Quality Program Manager - RN

Hours:                                   Full Time

Job Details:

Horizon Healthcare Staffing is searching for a clinical quality program manager for one of our clients located in Hackensack, New Jersey. The clinical quality program manager will be responsible for implementing and managing clinical programs that are aimed at providing safe, reliable and the highest quality of care to patients and families who receive care from our client’s practices.

• Accountable for ensuring the clinical programs meet the requirements and outcomes of payment arrangements including but not limited to the Oncology Model of Care (OCM), Merit-based Incentive Payment System (MIPS) and other Value-based Shared Savings Programs with public and commercial insurers.
• Constantly measures and monitors the effectiveness of programs and initiatives in place to ensure structures and processes fully support desired patient outcomes.
• Works very closely with assigned division and partners as well as leadership to advance the goals of the organization.
• Utilizes continuous quality improvement process, techniques and state of the art technology to identify gaps in care processes, opportunities to decrease overall costs in care, excel in quality measures and improve overall patient experience in the assigned division and practices.

Job Duties and Responsibilities:

• Carry out timely assessments and/or audits of performance of clinical quality including access, cost and patient experience measures, of assigned division and practices compared to targets and benchmarks
• Analyze results of assessments and any programmatic audits and initiate plan of correction to address gaps to goals
• Communicate, educate and work with divisions and practices regarding clinical programs and initiatives put in place to meet OCM, MIPS and other value based payer programs requirements such as Practice Redesign and Clinical Improvement Activities
• Lead division and practice specific interventions to ensure timely access, appropriate site of services, including but not limited to Triage, care management/care coordination and other patient navigation services
• Develop standardized referral workflows to behavioral health agencies, community organizations and agencies supporting survivorship and where appropriate, workflows to identify patients needing advance care planning and end of life conversations
• Serve as resource and expert for new practices and assist in their successful integration
• Participate in conference calls, meetings, and webinars

Knowledge and Experience:

• RN or equivalent health care professional
• Minimum 3 years’ experience in acute care setting, ambulatory physician practice management and/or administration of health plan benefits and other payer experience
• Knowledge and experience in continuous quality improvement process and other cyclical data driven performance improvement method
• Oncology practice experience a plus
• Knowledge of MACRA, MIPS, OCM and other value based programs a plus
• Experience working with community care organizations especially supporting cancer care a plus

Education:

• Bachelor of Science in Nursing or related health care degree
• Certification in quality and/or project management preferred
• Master's degree preferred