Sponsored Programs Director jobs in Vincennes, IN

Position Summary: MPM Nurse navigator works in collaboration with the primary care provider and all members of the respective health care team in multiple primary care offices through the division of Medical Practice Management. Develops QUALITY initiatives to assess and coordinate improving quality outcomes and plans of action related to open care gaps and unmet health maintenance topics. Responsible and accountable for the coordination of care across the continuum, education/provision of information and support for patients, facilitation of decision making, advocacy and ultimately improved throughput and patient satisfaction for designated patient populations. Assesses patient healthcare needs and identifies missing resources to promote whole quality care for the patient. Serves as a quality improvement advocate and assists in identification and improvement of service delivery.

The Nurse Navigator will monitor patient outcomes related to MIPS quality measures and Payer Incentive Program, HEDIS measures, and participate in quality improvement activities. Works in a multidisciplinary setting and collaborates with health care team members and payer incentive program representatives to positively impact patient outcomes and patient experiences, as well as payer incentive program outcomes. This position requires expertise in the nursing process, using critical thinking skills to plan and coordinate care, and insurance payer knowledge. HEDIS and STAR knowledge is also used to plan, coordinate, and grow the Payer Incentive Program. The nurse also serves as a clinical resource to other clinical staff.

Essential Functions: To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.

• Collaborate in overseeing the practice's chronic disease registries.
• Oversee the MPM Outpatient Payer Incentive Program. Collaborate POA with stakeholders to optimize ROI
• Assist (or Oversee) in overseeing the MPM MIPS Outpatient Quality Program
• Utilization of HEDIS quality measures and care gap reporting functions.
• Collaboration with IT Analyst to improve BPA's and meet MIPS reporting, care gap/HEDIS quality measure reporting requirements
• Serve as the main point of contact for Insurance companies and their representatives to develop quality measure closure strategies
• Serve as a clinical resource and financial resource within the practice.
• Participate in regular team meetings, huddles, staff meetings and quality improvement projects to improve patient care.
• Consult with the medical staff, nursing staff and ancillary department staff to eliminate barriers to the efficient delivery of care. Identify service delivery problems related to the capturing of care gaps and health maintenance topics and potential for effective patient management intervention.
• Maintain annual competencies for role.
• Follow-up with assigned patients for missing care gaps/HEDIS measures on all labs, tests and consults to ensure work is done.
• Document all communication with patient in electronic medical record.
• Document all necessary information within patient payor portals for complete and accurate submission of HEDIS measure documentation needed.
• Close, abstract, and submit open care gaps
• Work at different MPM office locations as needed.
• Perform all other duties as assigned.

Job Knowledge, Skills, and Abilities:

• Ability to work independently and exercise clinical judgment in interactions with Physicians, payers, patients and their families.
• Strong organizational and time management skills, as evidenced by a capacity to prioritize multiple tasks and role components.
• Strong analytical and data management skills.
• Aware of scope of practice boundaries, comfortable seeking direction and assistance from appropriate resources.
Communication
• - Ability to communicate effectively verbally and in writing. Excellent negotiation skills and motivational interviewing skills.
Computer Skills
• - Proficient ability to use a computer and electronic medical record.
Confidentiality
• - Maintain patient, team member and employer confidentiality. Comply with all HIPAA regulations.
Customer Service Oriented
• - Friendly, cheerful and helpful to patients and others. Ability to meet patients and others needs while following office policies and procedures.
Decision Making
• - Ability to make critical decisions while following MHHCC and MPM policies and procedures.
Delegating
• - Ability to allocate authority and/or task responsibility to appropriate team members, peers or superiors.
Flexibility
• - Ability to adapt easily to changing conditions and work responsibilities.
Positivity
• - Display a positive attitude and is a positive agent for change.
Project Management
• - Ability to organize and direct a project to completion.
Teamwork
• - Work as part of a team and collaborate with co-workers.
Working Under Pressure
• - Ability to complete assigned tasks under stressful situations.
• Liaison with insurance companies for patients with chronic illness.
• Reports to MPM Nurse Manager

Certification and Licensure:

• Current Indiana Registered Nurse licensure required
• CPR Certification required

Education and Experience:

• BSN required
• One to three years' experience of managed care, quality improvement and/ or provider contracting.
• One year of case management or managed care environment and/or quality services preferred.
• Extensive knowledge of HEDIS® quality metrics, Star Ratings, Value Based Contracting.
• Experience with utilization review and discharge planning required.

Performance Requirements:

Responsibility for:

Frequent interaction with a diverse population including team members, providers, insurance companies and other members of the public. Collects and maintains performance measures. Utilizes evidence-based care pathway to improve patient outcomes.

Physical Demands:
Visual, auditory, and speech acuity essential to evaluation patient and family/caregiver needs. May come in contact with hazardous health conditions; however, if proper procedure is followed no harm should come to employee.

Special Demands:
Reflects the mission, philosophy, core values, and customer service plan of Memorial Hospital and Health Care Center in action and attitude. Nursing practice reflects the American Nurse Associates Code of Ethics. Willingness to work with realization that errors and incompetence may have serious consequences for patients. Competency, tact, and patience are necessary when communicating with patients, families/caregivers, physicians, and other personnel. Utilizes initiative and judgment in adapting to meet the needs of the patient, family/caregivers, provider and support staff during the nursing process. Work hours may vary. Nurses are encouraged to be actively involved in the community as leaders in health and wellness promotion and injury and disease prevention. Professional appearance and attire required at all times.