Regulatory Quality RN Clinical Care-Intermediate

Presbyterian is seeking a Regulatory Quality RN Clinical Care-Intermediate

Responsible for PH Quality of Clinical Care (QOCC) activities. Investigates complaints alleging inappropriate Physical Health (PH) clinical care or alleged inappropriate behavior by a physician or other health care practitioner/provider. Applies the knowledge of a registered nurse to determine the key factors in each case and whether the standard of care has been met, documenting and summarizing findings for all parties regarding investigative findings. Collaborates on quality of clinical care work with PHP Business Partners including Medical Directors, Provider Network Operations, Credentialing, Care Coordination, Critical Incidents Team, and Legal counsel. Assists the provider peer review process which assesses and reviews the quality of patient and member care provided by practitioners and facilities.

This is a Full Time position - Exempt: Yes
• Job is based at Rev Hugh Cooper Admin Center
• Work hours: Days

Ideal Candidate: Bachelors in Nursing. Five years hospital nursing experience

• Bachelors in Nursing
• Five years hospital nursing experience
• Current NM RN License
• Skills in Outlook, Word, Excel, and Power Point
• Proficiency in writing or professional correspondence
  
  Preferred:
• Critical Care experience
• Complaint Management experience
• Quality Improvement experience
• Care Coordination/Case Management experience

• With guidance, reviews, responds to, and researches complaints related to quality of medical care utilizing a high level of knowledge and skill in nursing practice in order to discern the key factors in each case to ensure that all quality of care issues are identified and addressed.
• Provides referrals, as appropriate to the case, to correlating PHP entities including but not limited to: Legal, Risk Management, Behavioral Health QOCC Team, Provider Network Operations, Credentialing, Critical Incidents Teams, or Care Coordination.
• Perform Physical Health QOCC Case Management-all levels
• Conduct Practice Pattern Reviews
• Manage PIPs (Performance Improvement Plan)
• Conducts Medical Record Review (MRR)
• Prepare and Present Medical Director Reviews
• Attend Weekly Medical Records Huddle
• Writes QOCC Correspondence/Letters
• With guidance, writes and presents QOCC case summaries to PHP's Physical Health Professional Practice Evaluation Committee (PH PPEC).
• With guidance, manages and communicates PH PPEC recommendations including but not limited to: Practice Pattern Reviews, Performance Improvement Plans, and/or Recommendations for Terminations, Suspensions, or Admissions Holds.
• Other duties as assigned.

About Presbyterian Healthcare Services
Presbyterian offers a comprehensive benefits package to eligible employees, including medical, dental, vision, disability coverage, life insurance, and optional voluntary benefits.

The Employee Wellness Rewards Program encourages staff to engage in health-enhancing activities - like challenges, webinars, and screenings - with opportunities to earn gift to earn gift cards and other incentives.

As a mission-driven organization, Presbyterian is deeply committed to improving community health across New Mexico through initiatives like growers' markets and local partnerships. Founded in 1908, Presbyterian is a locally owned, not-for-profit healthcare system with nine hospitals, a statewide health plan, and a growing multi-specialty medical group. With nearly 14,000 employees, it is the largest private employer in the state, serving over 580,000 health plan members through Medicare Advantage, Medicaid, and Commercial plans.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.