Details
Posted: 28-Jan-25
Location: Oakwood, Georgia
Categories:
General Nursing
Job Category:
Nursing - LPN
Work Shift/Schedule:
8 Hr Evening - Morning
Northeast Georgia Health System is rooted in a foundation of improving the health of our communities.
About the Role:
Job Summary
The Clinical Quality Assistance (Assistant) LPN level 2 provides clinical expertise and matrix support to the clinical quality assistants (medical assistants). The Assistant participates cross-functionally with others internally and externally to support data driven results, uses patient outreach, education and expertise to ensure success of care gap closure for ambulatory care through clinician and patient engagement. The Assistant uses the nursing process to access, plan, evaluate and intervene where necessary in the care of patients by collaboratively working with other clinically licensed staff internally and externally (e.g., RNs, Pharmacists, Providers) to ensure patient care is optimum when addressing care gaps, including patient understanding of the importance of closing gaps. The Assistant plans, designs, educates, and supports NGPG's patient initiatives, programs, and projects implemented to improve patient outcomes. The Assistant coordinates CQA-level 1 staff in their outreach to patients and Providers to improve completion of a wide variety of preventative medical services for improving care gaps for all patients. The Assistant works closely with the Clinical Quality RN team and ambulatory pharmacy team to refer complex patient issues for resolution to other licensed team members, Providers, community resources and other NGPG leaders. The Assistant is responsible for new staff orientation and resource pool education. The Assistant is responsible for auditing medical records to support and/or validate data analytics and payor data and overlapping workflow issues with other NGHS affiliates identified through audits. CQA-level 2 LPN is responsible for all payor appointment agenda, patient assessment forms and other assigned HCC assessment forms. The Assistant is also responsible for special assignments and projects related to patient and practice staff education and engagement, identifying operational gaps contributing to less-than-optimal patient outcomes including practice workflow variants and educational deficiencies related to pay for performance and regulatory metrics and other outcomes supporting quality initiatives. Maintains current knowledge of NGPG practices, providers, and services as well as knowledge of current pay for performance and other quality measures. Develops and assists with a variety of quality improvement projects such as standard work and works effectively as a team member to ensure best quality care delivered to patients while maintaining confidentiality of business and protected health information. Identifies complex patient issues and refers same to care managers or other resources as needed.
Minimum Job Qualifications
Licensure or other certifications: LPN
Educational Requirements: High School Diploma or GED.
Minimum Experience: Five (5) years' experience in healthcare; Three (3) years in direct patient care in a clinical environment.
Other:
Preferred Job Qualifications
Preferred Licensure or other certifications:
Preferred Educational Requirements: Associates degree preferred.
Preferred Experience: At least 5 years with HEDIS measures/care gap closure/quality team experience preferred
Other:
Job Specific and Unique Knowledge, Skills and Abilities
Highly organized, work autonomously, self-motivated with the ability to adapt to various workspaces. Self-direct through multitasking and prioritizing.
Proficient with Microsoft Office applications (Word, Excel, Outlook, PowerPoint).
Excellent communication (verbal and written) and presentation skills to provide outstanding, personalized customer service and to instill confidence and to advocate for patients; ability to explain required information to patients in a comprehensible manner.
Microsoft Office and Excel knowledge (intermediate).
Must be creative and able to work in a fast paced, dynamic environment.
General knowledge of anatomy/physiology, casefinding, abstracting and follow up procedures, medical terminology and general clerical and computer expertise.
Ability to successfully navigate the electronic health record (EPIC) including Provider and clinic staff processes and workflows.
Understanding of population health concepts related to quality metrics and value-based contracts, care gaps, Quality Improvement, Medicare Stars, HEDIS measures and patient medical needs.
Ability to develop strong, trusting relationships with leadership, physicians, pharmacists, and patients.
Other professional skills and qualities: strong attention to detail, dependability, empathy, focus on quality, goal-oriented, ability to delegate and direct others, outstanding phone etiquette.
Must practice discretion and confidentiality as position deals with highly sensitive and private data.
Individual with a patient-first mindset, excellent problem solving and communication skills, who can thrive in an autonomous and evolving environment.
Essential Tasks and Responsibilities
Maintain up-to-date, current knowledge of a wide range of performance improvement, pay for performance, regulatory payor, and inhouse quality metrics that are required to collect, measure, and report patient outcomes.
Performs chart abstractions, chart audits and documentation reviews to comply with organizational policies and accreditation requirements.
Performs chart abstractions, chart audits and documentation reviews to support data requirements set by CMS and other third-party payors in order to optimize patient outcomes required by contracts, payor and other incentives and other regulatory policies. Performs and coordinators clinical documentation audits to be returned to payors.
Identifies and closes care gaps as part of quality incentives with value-based contracts with the goal of optimizing patient health and well being and meeting the goals of each contract, system entity goals and CMS reporting.
Provides educational and communication strategies, tools and resources to Providers, Provider groups and clinical practice sites, as needed, to enhance outcomes for all patients. Participates as a key member of the quality team to work with patients and providers to close gaps in care.
Coordinates, identifies and closes care gaps for all patient groups, prioritizing patients included in quality incentives and value-based contracts.
Perform chart reviews and data mining to obtain test results, lab results, and medical documentation that will close gaps in care.
Analyzes and utilizes data from available databases and data provided by third-party payors and NGHS collaborative partners in order to maximize closing care gaps, improve patient outcomes, and identify opportunities for process improvement.
Participate in workflows to support care gap closure.
Participate in deep dives to identify patients who are high cost/high utilizers and provide outreach as directed.
Use data to identify opportunities for process improvement and develop strategies to improve patient outcomes.
Provides at the elbow support and education to Providers and staff when deficiencies are identified to improve and achieve higher compliance scores on quality measures, NGPG goals, payor objectives and accreditation requirements. Schedule appointments with providers to address healthcare needs as needed.
Generates valid and accurate monthly quality reports from comparison files received from payors and in house reports collected from provider summary cards used to find gare gaps requiring reconciliation. Participate in the process to submit supplemental data to payers.
Conduct telephonic outreach and my chart messages to patients to close care gaps.
Work in conjunction with matrix partners to communicate care gap needs and actions.
Document all patient data/actions/interactions in all appropriate areas as deemed necessary.
Build rapport with patients, providers and clinical staff to identify strengths and barriers, promoting exceptional patient care while working to achieve success at quality metrics.
Participates in meetings with staff, Providers, payors and others to improve strategic use of data and improve quality outcomes and patient care.
Ensures requested results/consultation reports are received, reviewed and added to the electronic health record in an appropriate time frame needed to close care gaps. Scans results/consultation reports into electronic health record.
Receives and aggregates reimbursement monies received for budget and senior leader visibility.
Collaborates with and supports team members of the Clinical Quality & Ambulatory Pharmacy Services team with key projects and initiatives.
Mangages assigned roster of patients. Provide outreach to patients that have gaps in their care, to educate and encourage the patient to take action. Proactively communicate with the provider and/or clinical staff to facilitate needed care. Provides documentation as requested by collaborative partners required to close care gaps and assists team members with their payors when necessary including maintaining awareness of when to meet submission deadlines.
Maintain up-to-date, current knowledge and proficiency in changes in electronic health record changes that impact Provider and clinical staff workflows.
Designs, educates, and supports NGPG's patient initiatives, programs, and projects implemented to improve patient outcomes
Coordinates the Clinical Quality Assistants Level 1 and Level 2 goals and priorities
Provides new staff orientation and resource pool education.
Responsible for all payor appointment agenda, patient assessment forms and other assigned HCC assessment forms.
Develops and assists with a variety of quality improvement projects such as standard work and works effectively as a team member to ensure best quality care delivered to patients while maintaining confidentiality of business and protected health information
Assist with scheduling and triaging patients for appointments with providers.
Serves as clinical resource for MOA's and other non-licensed staff
Recognizes potentially untherapeutic patient care and escalates to the appropriate licensed clinical staff or intervenes when appropriate.
Complies a minimum of six hours continuing education within review year. Conducts at least one clinically related in-service for center staff during review year.
Assist with New Provider Orientation Education as needed
Other duties as assigned and/or as departmental priorities change.
Physical Demands
Weight Lifted: Up to 50 lbs, Occasionally 0-30% of time
Weight Carried: Up to 50 lbs, Occasionally 0-30% of time
Vision: Moderate, Frequently 31-65% of time
Kneeling/Stooping/Bending: Occasionally 0-30%
Standing/Walking: Occasionally 0-30%
Pushing/Pulling: Occasionally 0-30%
Intensity of Work: Frequently 31-65%
Job Requires: Reading, Writing, Reasoning, Talking, Keyboarding, Driving
Working at NGHS means being part of something special: a team invested in you as a person, an employee, and in helping you reach your goals.
NGHS: Opportunities start here.
Northeast Georgia Health System is an Equal Opportunity Employer and will not tolerate discrimination in employment on the basis of race, color, age, sex, sexual orientation, gender identity or expression, religion, disability, ethnicity, national origin, marital status, protected veteran status, genetic information, or any other legally protected classification or status.
