Registered Nurse - Quality Improvement

***QUALITY IMPROVEMENT NURSE: PART TIME IDEALLY 20 TO 24 HOURS PER WEEK  -  HOWEVER, WILL CONSIDER FULL TIME CANDIDATES AS WELL***

 

1. Assist in resolving patient complaints received by phone or mail from patients, family, staff, employer groups and HMOs.  Look for opportunities to improve the quality of care/service to the

patients of BPM. 

2. Receive formal grievance from HMO, then gather all pertinent information, prepare for Medical Director and/or the Quality Management Committee review. 

3. After grievance review by the Medical Director and/or the Quality Management Committee,

responds to appropriate parties.  Send letter to patients/HMO's reflecting a complete response to the concerns addressed in the complaint.  Letters are grammatically correct, error free and timely.

4. Maintain accurate documentation of patient information and grievance resolution in a concise, error free and timely manner. 

5. Complete all required chart audits as required by NCQA/HMOs in an accurate, complete and timely manner.  Review each medical record with the purpose of the audit in mind to ensure

consistent results.   

6. Perform Quality Management audits/surveys, as requested as a means to identify trends or

areas of concern. 

7. Review appointment access statistical information on an on-going basis for Access Audits.  Inform the Medical Director of any identifiable areas of concern. 

8. Follow-up on medical records sent to the QM Department as end line of the "recall system"

and "referral denial" system.  Send letters to the patients and HMOs as deemed necessary.

9. Per policy and procedures, prepare letters to send to patients and HMOs documenting non-compliance to medical advice or unacceptable behavior, to start the transfer/termination process. 

10. Meaningfully participate in Quality Management meetings.  Respond appropriately to committee member questions.

 

QUALIFICATIONS REQUIRED:

Valid California Registered Nurse License

minimum 3 years verifiable Q.I. experience