CLINICAL/QUALITY NURSE SPECIALIST (RN) New

Job Type: Regular

Time Type: Part time

Work Shift: Day (United States of America)

FLSA Status: Non-Exempt

When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.

POSITION FUNCTION: Reporting directly to the Manager, Patient Safety, the Quality Nurse Specialist performs duties in relation to the abstraction, submission and evaluation of externally reported performance data (inpatient and outpatient) to the Centers for Medicare, Joint Commission and Medicaid Services (Mass. Health) prior to deadlines. The Quality Nurse Specialist works closely with the Manager, Patient Safety to identify, prepare and coordinate the creation of peer review documents for medical staff and nonmedical staff review processes. Additionally, this role is responsible for collaborating and partnering with key clinical stakeholders to promote understanding of data abstraction guidelines as well as participating in and supporting process improvement activities.

Job Description:

DUTIES AND RESPONSIBILITIES:

• The Quality Nurse Specialist works closely with the Manager, Patient Safety to identify, prepare and coordinate the creation of peer review documents for medical staff and non-medical staff review processes.
• At the direction of the Manager, Patient Safety, facilitates, participates and/or coordinates performance improvement activities that may include but are not limited to committee work, data compilation, action planning and follow through as necessary.
• Maintains communication with medical coding staff to identify medical chart readiness for data abstraction.
• Facilitates the submission of patient files to the hospital’s intermediary vendor and performs data abstraction processes.
• Inputs abstracted data into electronic submission database within established time frames
• Generates, responds to and corrects reports of data abstraction errors/warnings as necessary. Generates rate reports for each of the abstractable metrics, analyzes them and distributes these findings and follow up to specific stakeholders
• Communicates as necessary with external regulatory and accrediting agencies in relation to abstraction/ submission processes.
• Validates data transmission from intermediary vendor to federal, state and accrediting agencies
• Evaluate and checks CMS (QNET)/MassQEX case detail/population and sampling reports and makes necessary corrections.
• Responds to and prepares medical records for regulatory agency validation requirements
• Runs recount reports for CMS.
• Responds to directives/requests from CMS, QNET and State QIO.
• Communicates revised abstraction specifications (as necessary) to Information Technology for file upload revisions to intermediary vendor – addresses any file upload failures or rejections as necessary.
• Collaborates and partners with key clinical stakeholders to promote understanding of data abstraction guidelines and supporting process improvement activities that lead to and promotes optimal organizational and system performance.
• Attends educational updates in relation to role as directed by the Manager, Patient Safety.
• Maintains competencies (position specific and hospital-wide) required for for this position.
• Performs all duties in accordance with safety and other laws, rules, and regulations set forth by appropriate regulatory and government agencies and in accordance with established department and hospital policies and procedures.
• May be required to perform similar or related duties as may be necessary on an emergency basis or as designated by the department manager or supervisor.
• The nature of the tasks/responsibilities required of employees in this position will likely expose them to blood and body fluids. Employees will be oriented to and required to understand and follow the standard precautions for infection control. A summary list of tasks and procedures that may cause exposure to blood and body fluids is listed in the attached Physical Abilities Job Description. Also identified is the protective gear that is available. The above statements are intended to describe the general nature and level of work being performed. This list is not to be construed, as an exhaustive list of all responsibilities, duties and skills required of personnel so classified.
  
  

QUALIFICATIONS: Minimum Education: Bachelor's Degree in Nursing (BSN) Minimum Experience: At least 3 years recent acute hospital clinical experience Previous experience and responsibility of data abstraction and leading performance improvement activities (preferred).

License/Certification: Licensed Registered Nurse: Massachusetts Skills/Credentials:  Computer proficient.  Detail oriented.  Strong communication/analytical skills.  Able to demonstrate collaboration and function effectively within team settings. A Physical Abilities Job Description is a component of this Job Description.

As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) and COVID-19 as a condition of employment. Learn more about this requirement.

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