QUALITY MANAGER / RN

RN / Quality Manager

This RN / Quality Manager position is full time on-site position, offer full benefits and a convenient day shift. The Quality Coordinator RN is a registered nurse who functions in a market quality leadership role in Population Health. This role helps drive quality best practices in a collaborative effort with payers, providers, support staff, managed care, VBC leaders and administration. The Quality Coordinator RN will participate in quality improvement initiatives, develop recommendations for quality remediation plans and create tools and databases to capture relevant data for their respective region. The QCRN will also be a leader for their local quality support team, with attention to apportioning responsibilities for quality support staff across their respective market. This role will also develop collaborative payer relationships to maximize resource utilization for patient care. Additionally, they will track quality performance on an ongoing basis with dissemination of performance metrics to key stakeholders (clinics, providers, administration) as a part of their leadership within a matrix relationship. The Quality Coordinator RN will be responsible for driving performance across plan metrics as outlined by the respective plans, optimize patient outcomes and system utilization, focus on STARS and HEDIS performance/metrics and help with MIPS measures. Additionally, the QCRN will help support quality staff competency and optimize clinic quality workflows within their region.

Job Duties:

• STARS/HEDIS and MIPS Performance
• Participate in the development of an annual work plan for improvement of STAR ratings, HEDIS and MIPS capture/performance from the position of the leader of the market quality team.
• Support system efforts that may include MSO initiatives, new payer contracts, and risk initiatives.
• Help create and support quality-based clinic workflows geared towards capturing gaps in care (chart scrubbing, pre-charting, huddles, Patient Care Conferences (PCCs)
• Support provider reviews of performance on a regular cadence (monthly preferable).
• Participate in payer meetings, create appropriate JOCs with payers.
• Analyze and evaluate provider group structure and characteristics, provider group/provider office operations and personnel to identify the most effective approaches and strategies
• Optimizing HCC capture and appropriately maximizing RAF
• Education of clinical staff concerning HCC capture and importance of RAF
• Develop and implement strategies for maximization of attestation form completion.
• Optimize AWV completion and promote as an opportunity for completing HCC capture
• Longitudinal Care Coordination
• Provide leadership of quality team in the ongoing development of quality and timely patient care across the care continuum
• Develop collaborative relationships across the patient care spectrum in the pursuit of warm patient hand-offs and a seamless care experience.
• Leadership of RN Care Managers and Population Health Coordinators within a collaborative environment, to maximize longitudinal care of the patients.

Benefits for full and part time employees: Challenging and rewarding work environment Competitive Compensation & Paid Time Off Excellent Medical, Dental, Vision and Prescription Drug Plans 401(K) with company match and discounted stock plan Career development opportunities within UHS and its 300+ Subsidiaries!

About Universal Health Services One of the nation's largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. has built an impressive record of achievement and performance. Growing steadily since its inception into an esteemed Fortune 300 corporation, annual revenues were $15.8 billion in 2024. During the year, UHS was again recognized as one of the World's Most Admired Companies by Fortune; and listed in Forbes ranking of America's Largest Public Companies. Headquartered in King of Prussia, PA, UHS has approximately 99,000 employees and continues to grow through its subsidiaries.

Qualifications Requirements: Graduation from an accredited nursing education program. Actively licensed by the worked in State to practice as a Registered Nurse. Minimum of 5 years of associated Population Health/Quality experience within the health care industry, preferably ambulatory based and includes experience with HEDIS/STARS and MIPS Bachelor's Degree Master's Degree, preferred Knowledge: Motivational Intervening Shared Decision Making Patient Centered Medical Home principles and Population Health principles (including care management, HEDIS/STARS and MIPS) Must demonstrate knowledge and ability to work effectively with all levels of personnel Knowledge of medical documentation requirements for meeting quality incentives Demonstrates awareness of and use of appropriate body mechanics Skills: Critical thinking, problem solving Must possess excellent communication skills and demonstrate team leadership and interpersonal skills Abilities: Must have the ability to problem solve and think critically Ability to work both independently and support a regional quality team Operate within the concept of patient centered care Ability to coach and mentor clinical and non-clinical staff Equipment Operated: Standard office equipment (laptop computer, fax, copier scanner) Pop Health/EMR software Work environment: Office or outpatient medical office setting Works in a well-lighted, OSHA Standard environment May be exposed to infectious and contagious diseases and bloodborne pathogens May be in contact with patients under a wide variety of circumstances Local ND domestic travel Occasionally subject to irregular hours May be required to wear personal protective equipment as necessary