Quality Care Support-RN

Rivers Health is seeking a full-time Quality Care Support Registered Nurse. This position will inputs quality data into patient chart pre appointment and reports information to the payer websites post patient appointment. Will assist, as needed, with the Transition Care Management Program, and other clinical duties as assigned.

ESSENTIAL JOB FUNCTIONS:

The following is a summary of the essential functions of the Quality Care Support job. The incumbent may perform other duties, both major and minor, that are not mentioned below; and specific functions may change from time to time.

• Work closely with representatives from patient insurance carriers.
• Obtain requested records from patient charts timely and accurately.
• Must respond timely and accurately to time sensitive emails/correspondence.
• Communicate with providers, as needed, to notify of open care gaps.
• Communicate with patients to explain importance/benefit of care gap closure.
• Coordinate and plan for deadlines for multiple insurance entity record submissions.
• Complete annual patient audit to ensure quality measures are
• Assist in giving testosterone injections.
• Assist in the function of the shot clinic.
• Maintain appropriate records for controlled medications.
• Make appointments for AWV, send/receive tasks, field phone calls as indicated.
• Abide by all HIPPA guidelines and regulations.
• Will assist with TCM (Transition Care Management) program including post discharge patient communications, coordination of services required, medication reconciliation, and any duties as assigned.
• Will communicate with patient, primary care providers, any diagnostic concerns.
• Will convey any clinical or psychological concerns to the patient's primary care provider to assure proper home care management after discharge.
• Will maintain clinical skills and continuing education to provide clinical support as needed.
• Will perform routine quality audits to ensure Joint Commission compliance.
• Assist in medication refills as needed.
• Maintains confidentiality.
• Performs other duties as required or assigned.
• Reports on the job as scheduled.
• Follows all standard safety precautions.
• Follows the standards of conduct and policies and procedures of St. Mary's Medical Center and applicable laws and regulations and reports violations through the appropriate chain of command.
• Annually completes required competency assessments.
• Utilize appropriate measures to promote and maintain patient safety.
• Makes decisions which include using the age of the patients treated when appropriate.
• Demonstrates knowledge of operation to include but not limited to the required unit specific equipment/procedures.
• Demonstrates knowledge of on-going unit specific performance improvement activities.

QUALIFICATIONS:

The following qualifications, or equivalents, are the minimum requirements necessary to perform the essential functions of this job.

EDUCATION AND FORMAL TRAINING:

Graduate of an approved School of Nursing and licensed as required by the West Virginia State Board of Nursing.

WORK EXPERIENCE:

Previous experience in area of specialty preferred. BLS required.

KNOWLEDGE, SKILLS AND ABILITIES REQUIRED:

BLS required.

STANDARDS OF PERFORMANCE:

Rivers Health is committed to providing excellent service to our customers. Each and every

interaction with your customers becomes an opportunity to serve. Every employee is

accountable for delivering an excellent customer experience. Pleasant Valley Hospital's

Standards of Performance pertains to: Attitude, Phone Etiquette, Customer Waiting,

Call Lights, Wayfinding, Privacy, and Facility Appearance.