We're Determined to Support New Mexico's Well-Being | Presbyterian Healthcare Services

Build your Career. Make a Difference. Presbyterian is hiring a skilled 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.

Some key responsibilities include:

• 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.

• 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

• Educational and career development options, including tuition and certification reimbursement, scholarship opportunities
• Staff Safety (a wearable badge that allows nurses to quickly and discreetly call for help when safety is a concern)
• Differentials for night/weekend shifts, higher education, certifications and various lead roles (for eligible positions)
• Malpractice liability insurance
• Loan forgiveness through the New Mexico Higher Education Department
• EPIC electronic charting system

Type of Opportunity: Full time FTE: 1.00 Job Exempt: Yes Work Shift: Days (United States of America)

About Presbyterian Healthcare Services Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses. Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans. AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.