Clinical Quality and Performance RN

At ConcertoCare, we are redefining care and aging for millions of US seniors and other adults with complex care needs by delivering human-first, tech-enabled care in the home. Our care teams leverage our value-based, interdisciplinary care model to address unmet health and social needs and to improve quality of life for our patients. We take a holistic, equitable, and compassionate approach to health and wellness in partnership with our patients and their families, caregivers, and communities. In short, we strive to offer the kind of healthcare that we would want our own loved ones to experience.

The ConcertoCare Clinical Quality and Performance (CQP) RN is an integral part of the ConcertoCare team and is a key driver of our commitment to continually improve the quality of patient care that we provide while ensuring patient safety. This role will primarily provide oversight and direction to the credentialing process for providers and serve as the clinical subject matter expert to monitor and ensure company Occupational Health procedures and protocols are in alignment with CDC guidelines. When applicable, the person will coordinate activities related to contractual requirements for delegated arrangements; and clinical regulatory requirements in support of external interfaces to demonstrate compliance with health plan partners and external regulatory entities regarding clinical audit. When necessary, they will also work with the VP, Clinical Quality & Performance, Population Health Leaders, and market teams to develop and implement programs and operations in support of organization-wide clinical quality, clinical pathway audit, and patient safety programs and organization-wide clinical policies. They will also work closely with the market quality champions/leads and other clinical leaders to ensure coordination and integration of efforts to improve clinical quality and ensure patient safety.

Ensures new provider welcome letters are sent, provider documentation is uploaded and validated, and maintains the confidentiality of all records. Provides prompt customer services to existing employees and new hires to ensure seamless payer enrollment experience. Serves as the primary contact for third-party credentialing vendor and point of contact for market leaders awaiting credentialing results. Notifies management and/or recruiters of payer enrollment issues; collaborates and advises as appropriate and escalates issues and concerns. Supplies new market updates and provides updates to existing market changes impacting enrollment. Ensures completion of government and state regulatory payer initiation and revalidation i.e., Medicare/Medicaid. Maintains a database file to store, track and maintain credentialing information. Supports clinical quality improvement activities including data review, audits, and reporting Monitors key clinical pathways reports, applicable dashboards and other reports for all markets and products Collaborates with team and market leadership to identify opportunities for clinical quality performance improvement and develops supportive plans to target opportunities using PI/QI improvement methods and tools. Conducts quality audits regarding clinical staff adherence to clinical pathways, tracks and trends, provides recommendations and expertise in improving adherence (e.g., training, focused audits) Conducts patient safety audits in focused clinical areas Tracks and reports safety events and near misses Coordinates root cause analysis and recommends performance improvement activities to address safety events and near misses. Works with the Population Health and Market teams to develop /deploy standardized organizational clinical policies and targeted training to improve patient outcomes. Works with Population Health and IT leaders to develop job aides, workflows, and training programs to support successful implementation of Population Health Improvement initiatives. Implements and conducts both external and internal clinical audits for delegation oversight programs inclusive of facilitating policies and procedures to ensure that all functions meet health plan and regulatory requirements. Collaborates with the VP, Clinical Quality & Performance to communicate audit findings and opportunities for process improvement specific to audit finding consistent with the organization’s vision and strategic long-term goals. Serves as the clinical subject matter expert, in partnership with the Occupational Health team, to monitor and ensure company Occupational Health procedures and protocols are in alignment with CDC guidelines. Responds promptly to Occupational Health concerns, providing expert clinical guidance and support. Collaborates with cross-functional teams to assist in auditing and completing Occupational Health requirements for employees. Contributes to the development and implementation of occupational health initiatives that promote employee wellness such as Occupational Health guidebooks and other materials. Participates in the collection, analysis, and reporting of data relevant to delegation oversight.