Provide nursing informatics and clinical quality support to Clinical Improvement Department and Quality Management Program for the ambulatory clinics of Colorado Health West. Promotes and provides data-driven, evidence-based process improvement activities and quality initiatives in the Colorado West HealthCare Systems clinics. Continuous assessment and monitoring of the quality of care provided, as well as regulatory trends. Ensure that the clinics are in compliance with CMS Conditions of Participation and all other regulatory and compliance entities in order to maintain or obtain accreditation, certifications and optimal reimbursement. Priorities are activities that promote continuous compliance and improvement activities to meet Medicare and Medicaid Conditions of Participation, regulatory and compliance entities, and others as needed to obtain or maintain accreditation, optimal reimbursement, and/or certifications. Accountable to oversee the collection, aggregation, reporting and submission of quality data by which the clinics are measured and reimbursement is obtained.
CWHS is committed to the provision of quality health care to the community it serves, and is accountable to collect, analyze, trend, monitor and submit data from which the organization is measured. Further, CWHS is committed to a continuous monitoring of the quality of care provided, and collects, analyzes, and presents data to the board and medical staff, providing actionable information and recommendations from which to assess clinical competence and quality outcomes.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
(The following statements are illustrative of the essential functions of the job and do not include other non-essential or marginal duties that may be required. Community Hospital reserves the right to modify or change the duties or essential functions of this job at any time. All responsibilities may not be performed by all incumbents.)
Monitors and collaborates to ensure technical and quality compliance with governmental/regulatory rules and regulations.
Coordinates quality activities, whether for reasons of patient safety, quality improvement, regulatory need, quality certifications, or contractual commitments to specific insurance company process improvement initiatives. Essential to this responsibility is the collection, abstraction, analysis and reporting of clinical data. One significant piece of this duty is the maintenance, mapping, monitoring and reporting of ambulatory electronic clinical quality measures within the electronic health record.
Develops systems and procedures to carry out QM/PI functions in alignment with accreditation/regulatory agencies and professional quality organizations, such as the Agency for Healthcare Research and Quality (AHRQ).
Keeps abreast of new and revised regulatory agency requirements, with additional emphasis on newer and evolving electronic quality reporting. Communicates these developments to the team, and collaborates on ambulatory clinic response to these changes.
Demonstrates familiarity with standards of accreditation and regulatory agencies. Collaborates with team in assessing adherence to these standards.
Provides abstraction, support, and education for data collection for provider reports.
Ensures the integration of Quality Management improvement activities and ongoing evaluation, including monitoring of appropriate corrective actions (management action plans) and improvements to ensure resolution.
Participates in drafting responses to quality measure queries from regulatory agencies as they concern ambulatory clinics, such as Hospital Quality Incentive Program (HQIPs) and Hospital Transformation Program (HTP) from Colorado Medicaid.
EDUCATION and/or EXPERIENCE:
Bachelor’s Degree in Nursing (Master’s Degree preferred) with at least two (2) years of experience with quality management/improvement, regulatory compliance, quality standards, and Joint Commission standards;
An equivalent combination of education and experience.
Current and unrestricted Registered Nurse license in the State of Colorado
BLS certification (required within 90 days of employment)
CPHQ (required within 3 years of employment)
Internal Number: 2
About Community Hospital
Community Hospital in Grand Junction, Colorado, is a full-service, acute-care hospital licensed for 60 beds. As part of the Colorado West Healthcare System, we offer full outpatient diagnostic services and inpatient care for the Western Slope region of Colorado, and eastern Utah. Community Hospital brings together expert staff and world-class technology in a healing, family-centered environment. We provide a full range of medical services, including inpatient and outpatient surgery,and emergency care. We have comprehensive diagnostic capabilities: state-of-the-art ultrasound, CT (Philips Ingenuity 128 MDCT), digital mammography and cardiac testing. Community Hospital proudly partners with University of Utah Heath Care and Huntsman Cancer Institute to provide world-class medical and radiation oncology right here at home. Community Hospital is Joint Commission accredited. Our laboratory is College of American Pathologists-accredited. For those lab tests that we don’t conduct on site, the Mayo Clinic is our exclusive partner for reference laboratory services. We pride ourselves on delivering personalized care to our patients, and in working closely with our medical-care providers in t...reating the whole person. This approach has resonated with our patients, and we are growing to meet our community’s demand. On October 15th, 2014, Community Hospital broke ground on a new four-story, 140,000 square foot, state-of-the-art facility. Our NEW hospital opened Thursday, March 17th, 2016! Where We LiveGrand Junction is located in beautiful Western Colorado and is the largest city in between Denver and Salt Lake City. An outdoor lovers paradise with hundreds of miles of mountain biking and hiking right out your front door. Fantastic winter and summer activities including skiing, snowmobiling, snowshoeing, camping, hiking and 4-wheeling on the Grand Mesa located just 45 minutes away. Enjoy the numerous lakes and rivers taht supply abundant opportunites for boating, rafting, paddleboarding, and fishing. Avoid the traffic with easy access to world class skiing in Aspen, Telluride, Vail, and Crested Butte.Come and tour one of the valley's 24 unique wineries and explore downtown Main Street with numerous unique shops and several delicious cafe's and restaurants. Journey through the awe-inspiring Colorado National Monument or catch an event at Colorado Mesa University or a Grand Junction Rockies baseball game. Your activity options are endless in Western Colorado. What do you want to do today?