Job Description

The Clinical Quality Nurse is responsible for performing clinical care reviews using criteria outlined by the Clinic’s various quality incentive programs (e.g., HEDIS, CMS, etc.). The Clinical Quality Nurse works with the providers and nursing staff to implement actions to improve performance, close gaps in care, and assist with the proactive management of the Clinic’s attributed patients. In addition, the Clinical Quality Nurse will assist in the validation of the quality metrics and measures used within the Clinic’s quality dashboards.

Job Relationships
Reports to the Quality Incentive Programs Manager

Principal Responsibilities
Participate in the review of quality measures and research the literature to determine the appropriate supporting documentation under the direction of the Quality Incentive Programs Manager.
Partner with Clinic’s internal departments to develop workflows to ensure quality measures are being captured appropriately and identify opportunities to improve current workflows to reduce the administrative burden on providers and front line staff.
Work directly with the providers and staff to review the results of clinical care reviews and assist in the development of interventions to improve performance.
Conduct follow-up clinical care reviews as needed.
Participate in planning and goal setting for the Department.
Conduct follow-up clinical data review as needed.

Working with Agilon/pod leaders to stay current with incentives.

Traveling to assigned sites (primarily care offices) and working with leadership.
Participate in planning and goal setting for the Department.
Comply with the Springfield Clinic incident reporting policy and procedures.
Adhere to all OSHA and Springfield Clinic training & accomplishments as required per policy.
Provide excellent customer service and adhere to Springfield Clinic's Code of Conduct and Ethics Standards.
Perform other job duties as assigned.

Education/Experience
Healthcare management or leadership experience preferred.
Minimum of five (5) years experience in a health care setting; medical office preferred.
Familiarity with EHR clinical products and experience with the implementation of clinical software.
Experience in medical record review and statistical data extrapolation.

Licenses/Certificates
RN or LPN with license in good standing in the State of Illinois. CPR certification per American Heart Association guidelines required within 30 days of hire.

Knowledge, Skills and Abilities
Ability to travel to multiple Clinic locations.
Expertise in Microsoft Office products (Word, Excel, Access, Outlook).
Must be able to meet deadlines and work under pressure while providing a positive image.
Ability to work independently in all levels of the organization.
Ability to learn applicable skills and adapt easily to changes in processes or workflow.

Maintaining relationships with payers to stay current on incentive programs and requirements.
Excellent organizational, verbal and written communication skills.
Strong leadership and motivational skills.
Strong background in business and integrated health care delivery.

Working Environment
Work in multiple clinic environments.
Requires sitting and standing for long periods of time.

PHI/Privacy Level
HIPAA1