The quality performance nurse will be responsible for collaborating with the hospital administrations, case management, quality teams as well as company physician teams to identify important pt care metrics, develop and implement action plans to improve provider group performance will include but not limited to reducing readmission rates, timeliness of discharge order completion, patient satisfaction and etc.
Additionally, this role will be responsible for creating and managing workflows that enable timely discharge to appropriate next site of care such as SNF or home with Chronic Care Management (CCM).
Essential Duties and Responsibilities (below are typical responsibilities and not an exhaustive list
of all duties, other duties may be assigned as needed):
Patient Interaction:
1. Processes referrals for all programs from hospital sites utilizing standard work and determines
steps necessary to ensure a smooth transition for the pt based on established guidelines.
2. Verifies care, skilled nursing and CCM or other benefits according to payor plans. Work with
hospital case management team to obtain authorizations for services as needed.
3. Ensures physicians care orders are obtained.
4. Identifies risk management situations and completes high risk referral process on all appropriate
patients based on established guidelines.
5. Interprets company services, admission criteria and medical policies to referral sources and
individuals seeking information.
6. Interviews patients/families in the hospital to identify opportunities for improved communications
and patient satisfaction with hospitalist services.
7. Works in conjunction with the case management staff to assist the patient/family in the initiation of
transitional care services. Responds to inquiries regarding transitional care services.
Hospital Interactions:
8. Works within hospital leadership to identify and track hospital performance metrics for our provider
group.
9. Develops action plans to drive improvement in performance metrics.
10. Meets at least monthly with hospital administration, case management, quality departments to
provide updates on action plans and performance improvement.
11. Provide quality customer service and promote collaboration, and coordination between referral
sources and hospital services to promote continuity of care.
12. Acts as a resource to physicians, hospital and designated skilled nursing facility staff (i.e. care
management, discharge planners, social workers, nursing) regarding types of services available
and the criteria for the services available including Medicare guidelines.
13. Provides education to the care team as requested on services that may enhance the transition of
care for patients.
14. Maintains knowledge of Medicare, Medicaid and HMO procedures.
15. Attends site based multidisciplinary meetings at least once per month at each assigned site (e.g.
readmissions, capture, discharge planning) to ensure hospitalists team engagement meets
hospital expectations and resolve any deficiency.
16. Assures appropriate follow-up to patient satisfaction issues relating to hospital care.
17. Provides courteous service to patients, families, staff, and physicians.
18. Work with hospitalist coordinators to ensure all clinical information is obtained for accurate and
timely billing.
19. Assists in the development of policies and procedures to ensure compliance with current practice
standards.
Provider Interaction:
20. Educate providers about the action plans and workflows to drive performance improvement in
hospital metrics.
21. Share individual performance metric data with each provider at least monthly and collaborate with
the provider to develop individual action plans as needed.
22. Participates in precepting new hire provider training and orientation.
23. Maintains competency by attending monthly training and interdisciplinary team meetings.
6. Ability to maintain patient confidentiality and follow medical office protocols to comply with HIPAA
and PHI requirements. Complete the annual HIPAA required trainings timely.
7. Proficiency with informational systems to facilitate the use of electronic medical records
(EHR/EMR) and Scheduling Software.
Education and Experience Requirements (education, licensure and certifications):
1. Valid and unrestricted Florida Registered Nurse License, BSN.
2. At least 3 years of hospital nursing experience as a Registered Nurse.
