Quality Management Nurse - Value Based Programs*

SAN-Bernardino-Count; Colton (CA); Presencial; USD 95.000 - 115.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Benefits package

MBO wage differential

Descripción de la vacante

Arrowhead Regional Medical Center (ARMC) seeks a Quality Management Nurse to oversee value-based program metrics, perform PLD reviews, and audit documentation for both outpatient and inpatient services. This role blends clinical expertise with data analytics to drive quality improvement.

The incumbent will identify charting gaps, collaborate with care teams, and educate providers on quality metrics within ARMC’s VBPs, ensuring compliance with regulatory requirements and program-specific goals.

Formación

• Must be a Registered Nurse licensed in California.
• Experience in performance improvement, quality management and/or patient safety is preferred.

Responsabilidades

• Review patient-level detail (PLD) files for QIP metrics.
• Audit charting and review clinical documentation for outpatient and inpatient services.
• Identify charting and coding gaps requiring remediation.
• Analyze quality metric performance and provide clinical insights.
• Collaborate with clinical and administrative teams to support documentation and quality improvement.
• Coordinate education and training for providers and staff on quality metrics.
• Participate in process improvement for Value-Based Programs (VBP) metrics.
• Analyze performance for QIP and IEHP P4P programs including HEDIS measures.

Conocimientos

Quality improvement

Data analysis

Clinical documentation

RN patient care

Utilization review

Educación

RN license CA

Herramientas

Descripción del empleo

Arrowhead Regional Medical Center (ARMC) is hiring for Quality Management Nurse - Value Based Programs who perform ongoing review of patient level detail (PLD) files for Quality Incentive Pool (QIP) metrics, audit charting, and documentation associated with outpatient services and inpatient stays; identify charting and coding gaps or errors which require remediation. This role offers a unique opportunity to combine clinical expertise, data analysis, and quality improvement within a dynamic public healthcare environment.

Duties may include, but are not limited to, the following:

• Perform ongoing review of patient-level detail (PLD) files related to Quality Incentive Pool (QIP) metrics.
• Conduct chart audits and review clinical documentation associated with outpatient services and inpatient stays.
• Identify charting and coding gaps or errors requiring remediation.
• Analyze quality metric performance and provide meaningful clinical insight based on assigned programs.
• Collaborate with clinical and administrative teams to support accurate documentation and quality improvement efforts.
• Coordinate education and training for providers and clinical staff related to quality metrics.
• Participate in clinical process improvement efforts related to Value-Based Programs (VBP) metrics.
• Contribute to a holistic understanding of ARMC’s quality performance and compliance with regulatory requirements.
• Analyze performance for all active value-based programs, including, but not limited to, the Quality Incentive Pool (QIP) and IEHP Pay for Performance (P4P) programs, including HEDIS measures.

VALUE BASED PROGRAMS

Value Based Programs (VBPs) reward public healthcare systems when high quality care is provided to patients. This is measured by several comprehensive quality metrics, audited by the Department of Health Care Services (DHCS) and contracted Health Plans. At ARMC, VBPs are designed to drive continuous improvement in quality of care through comprehensive data analytics and clinical review. Incumbents assigned to VBPs are responsible for identifying, quantifying, and providing holistic analysis on ARMC's quality metrics, dependent upon assignment.

ARROWHEAD REGIONAL MEDICAL CENTER

Located on a beautiful 70-acre campus in Colton, California (50 miles east of Los Angeles), Arrowhead Regional Medical Center (ARMC) is a state-of-the-art, public/nonprofit, 456-bed, university affiliated teaching hospital licensed by the State of California Department of Public Health and accredited by The Joint Commission. The hospital houses a regional burn center serving four counties (San Bernardino, Riverside, Mono and Inyo), a comprehensive stroke center, level I trauma center and a freestanding in-patient behavioral health center. Additionally, ARMC operates five community-based, primary care clinics and over 40 specialty care outpatient services. ARMC is the primary teaching hospital for the adjacently located California University of Science and Medicine (CUSM), the Inland Empire's newest medical school. To find out more about Arrowhead Regional Medical Center, please visit: www.arrowheadregional.org.

EXCELLENT BENEFIT

• To review job- specific benefits, refer to: Summary of Benefits Nurses Unit and the Memoranda of Understanding (MOU).
• The County also offers an alternative Modified Benefits Option (MBO) that provides a wage differential.

CONDITIONS OF EMPLOYMENT

Pre-Employment Process: Incumbents must pass a background investigation, which includes fingerprinting, work history and education verification, as well as a job-related physical exam and drug screening.

Training: Training will be provided online and administered at an ARMC and/or a County training facility.

Travel: Travel throughout the County may be required. Employees will be required to make provisions for transportation. Mileage reimbursement may be available.

Sponsorship: Please note San Bernardino County is not able to consider candidates who will require visa sponsorship at the time of application or in the future.

Candidates must possess ALL of the following:

LICENSE: Must possess and maintain licensure as a Registered Nurse with the State of California Board of Registered Nursing.

CERTIFICATION: Healthcare Provider level Basic Life Support certification issued by the American Heart Association.

EXPERIENCE:

OPTION 1: One (1) year of full-time equivalent experience in direct patient care as a Registered Nurse in an acute care hospital, primary care clinic, or Medicaid plan.

-OR-

OPTION 2: Two (2) years of full-time equivalent experience as a Registered Nurse in an acute care hospital, primary care clinic, or Medicaid plan with experience in performance improvement, quality management and/or patient safety, case management, utilization review/utilization management, or care coordination.

The ideal candidate will possess experience reviewing quality metrics for a Designated Public Hospital (DPH), primary care clinic, or Medicaid plan, or experience in case management, utilization review, or clinical documentation review involving chart audits, coding validation, or medical record abstraction.

Equal Employment Opportunity (EEO) / Americans with Disabilities Act (ADA) San Bernardino County is an Equal Employment Opportunity (EEO) and Americans with DisabilitiesAct (ADA) compliant employer, dedicated to ensuring equal employment opportunities for allemployees and applicants.

ADA Accommodation: If you have a disability and need accommodations during the testing process, please submit the Special Testing Accommodations Request Form within one week of the recruitment filing deadline.

Veterans’ Preference: Eligible veterans and their spouses or widows/widowers who are not current County employees may receive additional Veterans' Preference points. For details and instructions on how to request these points, please refer to the Veterans' Preference Policy.

For more important details, review the Applicant Information and County Employment Process.