Provides consultative services and manages quality improvement activities and initiatives for Provider Services. Contributes to the development of whole system measures and annual Enterprise quality strategic plan. Implements, monitors, and evaluates quality improvement strategies based on national benchmark data to achieve top decile performance.

Analyzes performance and recommends improvement initiatives and/or corrective actions. Utilizes a quality improvement framework, such as Six Sigma - Define, Measure, Analyze, Improve and Control or Plan, Do, Study, Act, to facilitate rapid cycle improvement strategies. Serves as a consultative resource to quality improvement committees and work groups. Integrates compliance and regulatory requirements into QI processes. Understands and interprets CMS/DOH standards and related policies and procedures. Works under general direction.

$93,400.00 - $116,800.00 Annual

What We Provide

• Referral bonus opportunities
• Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays
• Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability
• Employer-matched retirement saving funds
• Personal and financial wellness programs
• Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
• Generous tuition reimbursement for qualifying degrees
• Opportunities for professional growth and career advancement
• Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities
• Interdisciplinary network of colleagues through the VNS Health Social Services Community of Professionals

We You Will Do

• Collaborates with clinical management and field clinicians to identify, develop and implement quality improvement standards and criteria that meet program goals. Evaluates effectiveness of standards and recommends changes, as needed.
• Ensures Quality Improvement programs are aligned with State and National Quality Standards to achieve best in class quality outcomes as evidenced by better health for individuals, better health for populations, and lower costs for healthcare.
• Coaches and facilitates performance improvement activities designed to help teams and programs meet and exceed quality scorecard indicators. Instructs management and staff in the meaning and use of data for the purpose of assessing and improving quality.
• Participates in the development of standards and criteria for monitoring compliance with Federal and State regulatory requirements and VNS Health Provider Services performance standards of care. Develops performance measures and data collection instruments.
• Reviews and analyzes changes in the health status and outcomes of patients utilizing outcomes data. Consults and collaborates with clinical staff to identify trends and opportunities for improvement in health status and outcomes.
• Collaborates with operations management in the development of action plans based on quality reviews and root cause analysis findings. Makes recommendations to appropriate staff and/or committees about findings of reviews, surveys and studies.
• Investigates patient related complaints and quality of care (QOC) issues, incidents, and serious adverse reportable events in collaboration with internal staff and providers. Performs focused and comprehensive quality assessment reviews; identifies and analyzes results; prepares investigation summary reports; and creates/implements corrective action plan as appropriate. Analyzes data sets for trends and formulates opportunities for improvement based on those trends. Provides education about identified quality trends, outcomes of reviews and new requirements.
• Follows-up to ensure corrective actions for regulatory issues, compliance, or deficiencies identified in patient complaints/incidents were implemented effectively.
• Conducts audits of patient case records. Develops forms, record abstracts, reports, and other tools used to implement concurrent and retrospective patient/member case review, including the design, testing and evaluation of the review methodology.
• Collaborates with operations management to assure compliance with CMS/DOH/COP/CHAP requirements. Coaches, facilitates and monitors continuous improvement to attain strategic quality objectives and industry benchmarks for patient/member outcomes, satisfaction, cost and regulatory requirements.
• Participates in the coordination, review, revision and approval of policies and procedures for Provider Services. Identifies gaps and recommends creation of new policies.
• Drafts and ensures annual review and updates of Home Care policies; project manages the annual review of VNS Health operation policies.
• Participates in the preparation for and assists with site visits of outside surveyors/regulators for the purpose of regulatory compliance and accreditation.

• Current license and registration to practice as a Registered Professional Nurse. required
• Valid driver's license or NYS Non-Driver photo ID card, may be required as determined by operational/regional needs.
• Bachelor's Degree in Nursing required
• Master's Degree in Nursing preferred
• Minimum of three years of clinical experience in a health care setting, including at least two years with a focus on quality improvement and measurement required
• Knowledge of health care delivery systems, patient care, care coordination, and clinical processes required
• Ability to perform statistical/quantitative analysis required
• Proficiency in word, excel and PowerPoint required
• Experience in EMR navigation such as EPIC or HCHB required
• Excellent oral, written and interpersonal communication skills required
• Knowledge of basic Performance Improvement tools and methodologies required
• Experience in home care and/or hospice preferred