Registered Nurse - Rn-Quality Care

Premier Community Healthcare Group Dade City , FL 33525

Posted 2 months ago

Registered Nurse

  • Quality Care

General Description:

Under the direction of the Quality Care Services (QCS) Manager, the Quality Care Services (QCS) Nurse assesses, plans and coordinates all aspects of medical and supporting services across the continuum of care for assigned members to promote quality and cost-effective care, through the ongoing support of individual patient needs. The QCS Nurse provides the medical care team with patient utilization information, evaluate and addresses potential care gaps.

Essential Duties and Responsibilities:

  • Assess the level of need of individuals/families assigned for QCS management services including individuals with medically complex needs, chronic illnesses and intellectually challenged individuals

  • Conduct detailed analysis for the assigned patients to identify possible gaps in care and determine necessity of medical or non-medical interventions based on nursing knowledge, PCHG policies and procedures, and third-party payors guidelines

  • Provide ongoing outreach to a caseload of identified PCHG patients. Communicate with patients to encourage healthy behaviors and ensure patients are well informed and empowered to make proactive decisions about their own care and provide necessary education

  • Provides targeting coaching and education to care team members and providers as needed

  • Keep accurate records of caseloads and ensures that any required measures are completed and reported in a timely manner

  • Complete all documentation within 24hrs as per agency standard including case records, and case notes, and outcome measures

  • Meet regularly with QCS Manager to review cases and job performance

  • Collaborate with PCHG providers and clinical teams.

  • Schedule and maintain appointments with providers and clinics to provide education related to reviews

  • Perform plan-specific activities as required (Health Risk Assessments, Annual Wellness Outreach, etc.)

  • Maintain confidentiality within the workplace with all written and verbal communications pertaining to, staff, and community operations. Strict adherence to all State, federal, HIPAA, PCHG and accreditation agency rules and regulations

  • Ability to leverage best practices using advanced analytics models, and data driven strategies to improve and optimize patient outcomes.

  • Knowledgeable of HEDlS and the use of HEDIS gap reports/Meaningful Use reports/data reports in relationship to clinical visits/billing and some coding knowledge

  • Other duties as assigned

Supervisory responsibilities:

No supervisory responsibilities, but has clinical oversight for Medical Assistants within Quality Care Services

Knowledge, Skills and Abilities:

  • Strong oral and written communication skills

  • Ability to effectively navigate and enter data into an EHR; Strong Microsoft Office Suite skills, specifically Word, Excel, and ability to utilize data analytics programs

  • Excellent interpersonal skills and ability to develop and maintain effective working relationships with patients and coworkers

  • Highly organized, with excellent attention to detail and problem-solving skills

  • Ability to communicate effectively with patients and care team, while maintaining a professional demeanor

  • A self-motivated, independent, highly driven and results focused individual


  • Graduate of an accredited LPN or RN Program

  • Minimum two (2) years of experience as an LPN/RN in a healthcare

  • Minimum one (1) year of experience as a utilization review nurse or Case Manager with a successful track record in a health care setting

  • Active LPN or RN License in the State of Florida

  • Current BLS Certification

Working conditions and physical requirements:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

  • Ability to lift 20 lbs. regularly and 30 lbs.-50 lbs. occasionally.

  • Ability to sit for long periods of time.

  • Direct exposure to computer screen.

  • May be exposed to contagious/infectious diseases.

Registered Nursing Specialized Skills- Patient Care Treatment Planning

  • Planning Case Management- Patient Direction

  • Family Education and Instruction Clinical Experience-Acute Care

  • Safety

  • Process Improvement

  • Critical Care Pediatrics Medication Administration Care Plans

  • Screening- Nurse Management

  • Advocacy- HIPAA- Appointment- Data Entry- Immunizations- Trauma- Patient Flow- Caregiving- Triage-Computer EMR-HER Electronic Medical Records- Heath- Trust

  • Respect

  • Integrity

  • Compassion

  • Excellence- Community Health- Office- Front Desk- Doctors office- Health center- Infection

  • Vitals- Injection

  • Office Equipment

  • Risk Management

  • First Aid

  • Procedure

  • Wounds

  • Patient Preparation

  • Meditech

  • Greenway

  • Intergy

  • Dentrix

  • Dexces

  • Phreesa

  • Grants

  • Family Medicine, Pediatrics, Women Services, Dental, Behavioral Health problem resolution

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Registered Nurse - Rn-Quality Care

Premier Community Healthcare Group