Clinical Quality Manager

: Category: RN Professional City: Bolivar State: Tennessee Shift: 8 - Other Shift (United States of America) Summary: OverviewUnder the supervision of the Administrator, responsible for the organization and coordination of patient care and outcomes management in an assigned service line or for a designated patient caseload. Responsible for management of resources necessary for the achievement of optimal clinical and financial outcomes across the continuum of care, from pre-admission through post-discharge. Current RN licensure as approved for practice in the State of Tennessee. Responsibilities Establishes a system for coordinating a caseload of patients throughout the continuum of care. Reviews plan of care for all patients in caseload to assure appropriateness of care provided utilizing admission and continued stay accepted criteria. Obtains or facilitates acquisitions of urgent/emergent authorizations, continued stay authorizations, and authorizations for Post-Acute services as needed and with compliance with all regulatory and contractual requirements. Maintains a working knowledge of care management, care coordination changes, utilization review changes, authorization changes, contract changes, regulatory requirements, etc. ; serves as an educational resource to all WTH staff regarding utilization review. Assumes roles in assessment physical, psychosocial & economic needs for transition of care planning to a variety of levels of care; delegates to others as appropriate. Interviews and collects patient specified data and chart review related to readmission and appropriately notifies care team Communicates telephonically and electronically with outpatient providers in an effort to enhance the continuum of care. Collaborates with the Nursing Department and Social Services to coordinate patient care and appropriately identify and utilize clinical and financial resources. Maintains record of all worksheets relative to Case Management. Coordinates quality utilization and outcome activities. This includes review of patient medical record for appropriateness of continued inpatient stay and quality of care issues. Prepares and submits required reports to committees and others as needed. Provides concurrent review of clinical documentation in the medical record and assists physicians to identify that co-morbidities, present on admission conditions, and complications are documented appropriately. Participates in the compiling of monthly and quarterly utilization reports and comparative data on physician practice patterns. Coordinates the discharge planning meetings on assigned unit. Assesses case load for trends and patterns, identifying and reporting common themes and variances. Assists with abstraction of clinical records for Quality Measures and providing education to clinical staff and physicians related to quality measures. Responsible for the administration of the Quality Net account and downloading and sharing that information with appropriate personnel. Responsible for receipt and dissemination of information from The Joint Commission and assisting all staff with interpretation of standards and coordination of Joint Commission surveys. Assists in providing information and education as necessary to physicians and ancillary Endorses and promotes Guest Excellence and Quality PLUS in all activities, supports the philosophy and goals of Milan General Hospital. Performs related responsibilities as required or directed. Qualifications EDUCATION: Bachelor of Science in Nursing required. Candidates who are within 6 months of completion of BSN degree will be considered. LICENSURE, REGISTRATION, CERTIFICATION: Current licensure as a Registered Nurse as approved for practice in the State of Case Management certification preferred. EXPERIENCE: Three years experience in nursing in area of clinical expertise, preferred. Knowledge of the assessment of data, planning and coordination of care that will impact the fiscal management of patient care as acquired through on the job training. Knowledge of hospital policy and operations, medical and nursing staff procedures, hospital and community resources as acquired through on the job training. NONDISCRIMINATION NOTICE STATEMENT We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, ethnicity, disability, religion, national origin, gender, gender identity, gender expression, marital status, sexual orientation, age, protected veteran status, or any other characteristic protected by law.