RN Quality Manager

HarmonyCares is one of the nation’s largest home-based primary care practices. HarmonyCares is a family of companies all dedicated to providing high-quality, coordinated health care in the home. This includes HarmonyCares, HarmonyCares Medical Group, HarmonyCares Home Health, HarmonyCares Hospice and The Home DME.

Our Mission – “Through Compassionate Patient-Centered Care in the Home; We will Provide Exceptional Outcomes across our Continuum of Services”

Our Values – Respect, Integrity, Teamwork and Excellence - are leading us to a better tomorrow for patient care.

Why You Should Want to Work with Us

• Health, Dental, Vision, Disability & Life Insurance, and much more
• 401K Retirement Plan (with company match)
• Tuition, Professional License and Certification Reimbursement
• Paid Time Off, Holidays and Volunteer Time
• Paid Orientation and Training
• Great Place to Work Certified
• Established in 11 states
• Largest home-based primary care practice in the US for over 28 years, making a huge impact in healthcare today!

Position Description

The RN Quality Manager will drive consistency, efficient processes and share best practices in a collaborative effort designed to facilitate improved quality performance. The RN Quality Manager will be responsible to analyze, develop, implement and monitor clinical quality management initiatives.

The RN Quality Manager will participate in quality improvement initiatives, attend practice meetings as necessary, develop recommendations for quality remediation plans, and create tools and databases to capture relevant data for their assigned region. This position will work collaboratively with the regional medical group team in a matrix relationship. This position will serve as the subject matter expert for ACO MSSP and Star measures and has responsibility for the region’s quality measure performance for value based payer programs.

Essential Duties and Responsibilities

• Develop and analyze market business plans as a tool for motivating providers and group leadership to engage in improving ACO MSSP and MAPD Stars measures to reach organizational goals
• Provide analytical interpretation of Stars and HEDIS reporting, including executive summaries to plan and provider groups
• Be the primary subject matter expert for all MSSP and Stars related activities within their assigned market(s) working within a matrix relationship which includes central Quality team operations and medical group clinical and operational teams
• Lead or participate and present in weekly, Monthly, Bi-monthly, Quarterly and/or Annual business Review meetings related to Star activities which summarize provider and office performance as requested
• Analyze and evaluate provider and practice structure and characteristics, provider group/provider office operations and personnel to identify the most effective approaches and strategies
• Assist in developing of training and educational materials for Stars and HEDIS
• Lead office education sessions around quality initiatives which may include providers, clinical support staff, and administrative personnel
• Function as the primary liaison between practice offices and HarmonyCares centralized teams related to quality initiatives
• Function as the primary liaison between practice offices and HarmonyCares related to quality initiatives
• Support Quality Management Performance Improvement plan/initiatives
• Identify community standards, benchmarks, and best practices
• Assess company performance to community standards, benchmarks, and best practices to identify improvement opportunities
• Assess High volume, high risk, high cost and/or problem prone processes to identify improvement opportunities
• Collect and analyze data and interventions for quality improvement studies and activities
• Recommend changes/enhancements to the Quality Management policies and procedures
• Partners with physicians/physician staff to find ways to explore new ways to encourage member clinical participation in wellness and education

• Works with office-based staff to ensure accuracy in medical records for data collection, data entry and reporting. Enters documentation of findings in identified databases
• Other duties/projects as assigned

Required Knowledge, Skills, and Experience

• Current unrestricted Registered Nurse License
• 4+ years of healthcare experience, including experience in a managed care setting
• 4+ years of experience in HEDIS/Star programs, preferably in a clinical quality consultant role and/or ACO MSSP program experience
• 2+ years of experience in provider facing interactions, including provider education
• 2+ years of experience with data analysis and/or quality chart reviews. Must be able to review data and provide recommendations for improvement
• Experienced using Microsoft office applications, including databases, word-processing, and excel spreadsheets. Must be proficient in Excel
• Up to 25% travel, with occasional overnight travel, as needed

Preferred Knowledge, Skills, and Experience

• Bachelor of Science in nursing
• Postgraduate degree in related field (MHA, MBA, MPH, etc.)
• Billing, CPT, CPTII coding experience
• Knowledge of NCQA, HEDIS and Medicare Stars rating, health plan accreditation standards, and CMS regulations for quality Knowledge of process and performance improvement methods and tools: Plan Do Study Act (PDSA) or Define, Measure, Analyze, Improve and Control (DMAIC)

Won’t you join us? We are seeking candidates who desire the opportunity and experience of delivering quality and compassionate healthcare - within proven care models – to elderly individuals and those with complex medical issues, who are the forefront of everything we do.