Float Nurse/Quality Reporting

Job Description

Job Description

Description:

Department: Outpatient Primary Care

Reports To: Clinic Director

FLSA Status: Non-Exempt

Work Locations: Tahoka (primary), O’Donnell, Post Clinics

Position Summary

The Primary Care Clinical & Quality Coordinator is a hybrid role supporting outpatient primary care operations across multiple clinic locations. This position combines direct patient care and clinic coverage with responsibility for quality metric management, payer reporting, and care gap closure across Medicare, Medicare Advantage, other insurance plans, and Accountable Care Organizations (ACOs).

The role plays a key operational function in maintaining clinic access, improving quality performance, supporting value-based reimbursement, and coordinating population health activities across Rural Health Clinics (RHCs) and Provider-Based Clinics (PPS).

Primary Responsibilities

Clinical Care & Clinic Coverage (Approx. 20–30%)

• Provide direct patient care within scope of licensure and training in outpatient primary care.
• Float between clinic locations to support:
• Vacation and leave coverage
• Staffing gaps
• Increased patient volume
• Support care coordination, patient education, and follow-up.
• Assist providers with preventive care workflows, chronic disease management, and documentation.
• Support standardized clinic workflows across 2 RHCs and 2 PPS clinics.
• Maintain flexibility to work across Tahoka, O’Donnell (~15 min), and Post (~25 min).

Quality, Population Health & Value-Based Care (Approx. 40–60%)

• Serve as assisting the Clinic Director with clinic quality metrics, including:
• Internal quality metrics
• CHIRP quality reporting
• RAPPS quality reporting
• Medicare
• Medicare Advantage plans
• Other insurance quality programs
• Accountable Care Organizations (ACOs)
• Manage and coordinate quality reporting requirements for:
• ~20–30 Medicare Advantage plans
• At least 1–2 ACO relationships
• Proactively identify, track, and support closure of care gaps, including but not limited to:
• Preventive screenings
• Chronic disease measures
• Annual Wellness Visits (AWVs)
• Quality measure documentation gaps
• Work directly with providers, nursing staff, and front-office teams to:
• Develop workflows to close care gaps
• Improve documentation accuracy
• Increase compliance with payer requirements
• Coordinate outreach efforts (calls, reminders, scheduling support) to improve patient compliance.
• Prepare and deliver regular quality performance reports to clinic leadership.
• Own quality reporting end-to-end, while coordinating as needed with:
• Revenue Cycle
• IT/EHR support
• External payer or ACO partners

Chronic Care Management (CCM) & Care Coordination Responsibilities (Approx. 20–30%)

• Support the delivery and ongoing management of Chronic Care Management (CCM) services for eligible patients with multiple chronic conditions, coordinated with the Clinic Director.
• Identify patients eligible for CCM enrollment in coordination with providers and clinic leadership.
• Assist with CCM patient enrollment activities, including:
• Patient education on CCM services
• Consent documentation per Medicare and payer requirements
• Perform CCM-related clinical and care coordination activities within scope of licensure, including:
• Care plan support and updates
• Medication reconciliation assistance
• Coordination with specialists, hospitals, home health, and community resources
• Conduct and document non–face-to-face patient outreach related to chronic condition management, follow-up, and care coordination.
• Support accurate and timely CCM documentation in the EHR to meet:
• Medicare requirements
• Medicare Advantage plan requirements
• ACO expectations
• Track CCM activities and time to support compliant billing and reporting.
• Work closely with providers to:
• Ensure care plans are current and actionable
• Address care gaps related to chronic disease management
• Collaborate with Revenue Cycle and leadership to support compliant CCM workflows and optimization opportunities.
• Monitor CCM program performance and contribute to continuous improvement efforts.

Operational & Leadership Support

• Act as a bridge between clinical operations, quality requirements, and payer expectations.
• Support training and education of clinic staff related to:
• Quality metrics
• Documentation standards
• Care gap workflows
• Participate in payer, ACO, and internal quality meetings as assigned.
• Identify opportunities to improve performance under value-based contracts.
• Support continuous improvement efforts across outpatient clinics.

Required Qualifications

• Clinical licensure or certification as one of the following:
• LVN/LPN
• RN
• Experience in outpatient primary care, rural health clinic, or similar setting.
• Familiarity with:
• Medicare and Medicare Advantage
• Other insurance quality programs
• ACO or value-based care concepts
• Strong organizational and documentation skills.
• Ability to work independently and manage multiple priorities.
• Willingness and ability to travel between clinic locations.
• Proficiency with EHR systems and reporting tools.

Preferred Qualifications

• Experience with:
• Quality reporting (CHIRP, RAPPS, payer portals)
• Medicare Advantage or ACO quality measures
• Annual Wellness Visits and preventive care workflows
• Rural healthcare experience.
• Prior involvement in population health or quality improvement initiatives.

Key Competencies

• Patient-centered clinical care
• Attention to detail and data accuracy
• Ability to translate quality metrics into practical clinic workflows
• Strong communication across clinical and administrative teams
• Flexibility and adaptability in a rural healthcare environment