Program Coordinator – Ambulatory Quality & Cancer/PCMH Accreditation

nashvillegeneralhospital; Nashville (TN); On-site; USD 90,000 - 130,000; Full time

Job summary

Nashville General Hospital is seeking an experienced Nursing Leader to provide clinical oversight, program coordination, and quality management across ambulatory oncology and specialty services.

The role partners with operational, clinical, and executive leaders to improve patient outcomes, ensure accreditation readiness (CoC, NCQA PCMH), and drive continuous quality improvement across ambulatory settings.

Qualifications

• RN license in Tennessee (unrestricted) required.
• BSN required; MSN preferred.
• Minimum 5 years nursing experience with leadership or program management.
• Oncology or cancer program experience preferred.

Responsibilities

• Lead CoC program for ambulatory oncology practices and ensure accreditation readiness.
• Coordinate NCQA PCMH recognition activities and related documentation.
• Develop scorecards and dashboards for quality, patient safety, access, and regulatory performance.
• Oversee ambulatory quality and operations across multiple service lines.
• Mentor nursing staff and coordinate education for new therapies and protocols.
• Collaborate with executives and departments to improve care delivery and compliance.

Skills

Nursing leadership

Quality improvement

Project management

Data analysis

Communication

Education

RN license in TN

BSN required

MSN preferred

Tools

EMR systems

Quality reporting tools

Data dashboards

Job description

This position requires a licensed nurse with demonstrated leadership experience to provide clinical oversight, program coordination, and quality management across ambulatory oncology and specialty services. Cancer experience is preferred.

In addition to cancer program leadership, this role supports ambulatory quality and accreditation initiatives including the NCQA Patient-Centered Medical Home (PCMH) program and other quality programs impacting primary care, multispecialty, endoscopy, infusion, and specialty services.

The Coordinator partners with operational, clinical, and executive leaders to improve patient outcomes, strengthen compliance, optimize clinic operations, and advance a culture of continuous quality improvement across ambulatory settings.

Essential Duties and Responsibilities

Commission on Cancer Program Leadership

Serve as the designated operational lead for the Commission on Cancer program for Nashville General Hospital ambulatory practices.

Coordinate all activities required to achieve, maintain, and enhance CoC accreditation status.

Ensure all program activities, evidence, and documentation comply with CoC standards.

Interpret CoC standards and translate requirements into actionable workplans for clinical and administrative teams.

Prepare for surveys, site visits, mock reviews, annual submissions, and reaccreditation cycles.

Facilitate Cancer Committee and multidisciplinary Cancer Conference meetings, including agendas, minutes, attendance, CME documentation, follow-up actions, and case coordination.

Coordinate with physicians to identify cases for conference presentation and track care recommendations discussed during conferences.

• Manage all CoC standard data reporting, quality studies, dashboards, and required submissions.
• Partner with the Cancer Registrar to monitor follow-up metrics, concordance reviews, and required corrective actions.
• Collaborate with the Cancer Liaison Physician (CLP) to implement, track, and report quality initiatives.
• Coordinate with research staff to support clinical trial screening, enrollment goals, and program compliance metrics.
• Lead community outreach, survivorship, screening, and prevention activities in collaboration with community partners.
• Serve as liaison with the American Cancer Society, Tennessee Cancer Coalition, and state cancer registry partners.
• Maintain ongoing readiness status and serve as subject matter expert for CoC requirements.

NCQA PCMH Program Oversight

• Coordinate activities supporting NCQA Patient-Centered Medical Home (PCMH) recognition for ambulatory primary care practices.
• Maintain documentation, evidence files, workflows, and policies required for PCMH recognition.
• Collaborate with practice leadership to improve access, care management, population health, patient experience, and team-based care processes.
• Monitor PCMH performance measures, readiness timelines, and re-certification milestones.

Ambulatory Quality & Operations Leadership

• Lead quality improvement initiatives across primary care, multispecialty, oncology, infusion, renal, and endoscopy service lines.
• Identify operational gaps in clinic flow, patient throughput, scheduling, access, and coordination; implement process improvement plans.
• Develop and maintain scorecards for quality, patient safety, access, throughput, patient satisfaction, and regulatory performance.
• Facilitate root cause analyses, workflow redesign, and performance improvement projects.
• Coordinate Joint Commission readiness activities, mock tracers, surveillance rounds, corrective actions, and staff education.
• Audit clinical documentation and workflows for Joint Commission and CoC compliance.
• Develop EMR templates, clinical tools, and documentation standards to support regulatory compliance and efficient operations.
• Support referral management, continuity of care, prior authorizations, and transitions of care as operationally needed.
• Review reimbursement denials related to medications or infusion services in collaboration with revenue cycle and pharmacy.

Nursing & Clinical Leadership

• Provide advanced oncology nursing guidance and clinical leadership for ambulatory oncology services and related specialty programs.
• Support staff competency validation, orientation, annual skills review, and ongoing professional development.
• Coordinate education for new therapeutic agents, biologics, and evolving treatment protocols.
• Train and mentor nursing staff on complex clinical procedures including vascular access care, ostomy care, phlebotomy, infusion therapies, and related ambulatory procedures.
• Support chemotherapy competency programs, administration standards, handling, and disposal policies in partnership with pharmacy and environmental services.
• Provide clinical support and staffing coverage during critical shortages or operational disruptions, including nursing and clinic support roles as appropriate.
• Assist with patient symptom triage, care coordination, prescription refill workflows, and urgent clinical concerns.
• Coordinate interdisciplinary care plans and transitions across inpatient, outpatient, and specialty settings.

Leadership & Administrative Management

• Assist with departmental budgeting, staffing plans, productivity monitoring, contracts, and expense management related to cancer program and ambulatory specialty operations.
• Support hiring, onboarding, coaching, performance evaluations, and corrective action processes consistent with hospital policy.
• Maintain vendor credentialing, specialty drug program enrollment, REMS compliance activities, and applicable external program requirements.
• Prepare executive reports, dashboards, presentations, and strategic updates for leadership.

Qualifications/Education

• Associate or Bachelor of Science in Nursing required; Bachelor of Science in Nursing preferred.
• Current unrestricted Registered Nurse (RN) license in the State of Tennessee required.
• Master's degree in Nursing, Healthcare Administration, Public Health, or related field preferred.

Experience

• Minimum 5 years of nursing experience required.
• Minimum 3 years of leadership, program management, quality, or ambulatory operations experience preferred.
• Oncology or cancer program experience preferred.
• Experience with Commission on Cancer standards strongly preferred.
• Experience with NCQA PCMH recognition preferred.

Knowledge, Skills, and Abilities

• Strong knowledge of ambulatory nursing operations, oncology workflows, accreditation, and regulatory frameworks.
• Expertise in quality improvement methodologies (Lean, PDSA, RCA, Six Sigma).
• Strong leadership, communication, and project management skills.
• Ability to analyze data and drive measurable outcomes.
• Ability to manage multiple priorities while maintaining focus on CoC program success as the primary responsibility.

Key Performance Expectations

• Maintain successful Commission on Cancer accreditation and readiness status.
• Meet all deadlines for CoC reporting, conferences, and committee activities.
• Sustain or achieve NCQA PCMH recognition goals.
• Improve ambulatory quality metrics across primary care, multispecialty, oncology, infusion, renal, and endoscopy services.
• Improve patient access, care coordination, compliance, and operational efficiency.

Education

• Degree/Diploma – Program of Study – Required / Preferred
• Bachelors – Nursing – Required
• Masters – Nursing – Preferred