An RN/NP who is responsible for organizing, coordinating, evaluating and documenting quality management integrated nursing –must use their clinical acumen to deliver the best care path and treatment options to our member narrative. Performs medical Quality Assurance(QA) reviews on all narratives in various stages. Interfaces, with physicians, sub-specialists, RN’s and intake coordinators. Is able to give and receive constructive feedback. Able to write and footnote narratives in a templated format creating process.



Essential Functions:



Reviews and audits all patient case files to identify incomplete, incorrect or unclear information to ensure the accuracy and reliability of patient documentation. References citations from research and treatment protocols in the development of process improvement recommendations.



Collaborates with others to evaluate performance trends and recommend interventions for improved performance, improved operations, modifications to and/or implementations of new procedures. Identifies issues and/or conflicts in Employer Strategy processes and utilizes Six Sigma approach towards the creation of standard work processes to ensure an environment of continuous performance improvement.



Obtains, reviews and analyzes clinical data through review of physician documentation, patient medical records and narratives and data reports from numerous sources. Collaborates with physicians, clinical specialists, 3rd party providers and payors, nurse practitioners and administrative leadership to develop processes to ensure accurate, timely, consistent access to relevant data. Presents data in a meaningful and useful manner.



Facilitates root cause analyses and other deep dive activities needed to refine and modify policies and procedures and/or processes to improve the quality of patient care and customer satisfaction.



Models behaviors that support improvement activities including critical thinking and multiple strategies identification. Coaches and supports physicians, clinical and non-clinical staff in using performance improvement strategies in their work, and supports physicians and staff by make recommendations and identifying performance improvement opportunities based on data. Incorporates improvement strategies to enhance quality of patient care and ensure patient, physician, and client satisfaction.



Oversees, fosters and supports the effectiveness of quality improvement projects to promote patient safety, enhance patient outcomes, mitigate risks and improve performance. Acts as an expert internal consultant for performance improvement activities, using data in recommending solutions to issues and success measures.



Follows established City of Hope and department policies, procedures, objectives, performance improvement, attendance, safety, environmental, and infection control guidelines, including adherence to the workplace Code of Conduct and Compliance Plan.



Practices a high level of integrity and honesty in maintaining confidentiality.

Performs other related duties as assigned or requested.



Position Qualifications:



Minimum Education: Master’s degree in Nursing

Minimum Experience: Five years as a Nurse Practitioner in a clinical oncology setting; Two years working in healthcare quality assurance or quality control

Req. Certification/Licensure: Current CA Nurse Practitioner license

Pref. Certification/Licensure: Advanced Oncology or Hematology nurse certification Six Sigma certification

Preferred Experience: Experience working in quality assurance for a health insurance provider Experience working for an academic oncology research institution



Skills/Abilities:

• Excellent/strong written and verbal communication


• Strong interviewing skills


• Work collaboratively across cross-functional teams and entities


• Ability to work fast and under deadlines


• Excellent organizational skills and attention to details


• Prioritize and perform multiple tasks simultaneously


• Excellent interpersonal skills

Software: Microsoft Office Suite (Word, Excel, and PowerPoint, etc.)