Primary Responsibilities
Quality Data Abstraction & Clinical Interpretation
- Collect, abstract, and validate clinical and operational quality data across all joint ventures, applying nursing knowledge to ensure clinical accuracy and completeness for internal and external reporting.
- Interpret clinical documentation, diagnoses, medications, and care plans within the EHR to accurately capture quality measure data that non-clinical abstractors may misread or miss.
- Maintain and update quality scorecards, performance dashboards, and tracking tools on a regular basis to reflect current performance across the JV portfolio.
- Generate recurring and ad hoc quality performance reports for the Quality Program Supervisor, joint venture leadership, and physician partners.
- Support accurate documentation and submission of quality and cost performance data in compliance with CMS, MSSP, ACO, and other value-based care program requirements.
Performance Monitoring, Gap Analysis & Clinical Assessment
- Monitor quality metrics and performance benchmarks across all joint ventures, flagging variances, trends, and care gaps for supervisor review and action.
- Apply clinical nursing judgment to analyze root causes of quality score variances, distinguishing between documentation gaps, true care deficiencies, and coding issues enabling more targeted and effective performance improvement interventions.
- Conduct clinical record reviews to identify missed or incomplete quality measure documentation, providing specific, actionable guidance to physicians and clinical staff for correction and improvement.
- Track care gap closure activities across joint ventures, coordinating with clinical staff and physician offices to ensure timely completion and documentation.
- Support the preparation of performance summaries and trend analyses to inform physician engagement and leadership decision-making.
Clinical Education & Provider Engagement
- Educate physicians and clinical staff on quality measure requirements, documentation best practices, and evidence-based care standards using clinical expertise to communicate in terms that resonate with care teams.
- Serve as a trusted clinical resource for physician partners and nursing staff, bridging the gap between quality program requirements and day-to-day patient care delivery.
- Lead or support clinical staff education sessions on risk adjustment documentation, chronic disease management coding, and preventive care measure completion.
- Review and interpret clinical guidelines and evidence-based protocols to inform quality improvement recommendations, translating complex clinical standards into practical workflows for joint venture partners.
Care Coordination & Transitions of Care
- Coordinate care gap closure workflows between hospital and physician group partners, applying clinical knowledge to triage urgency, identify high-risk patients, and prioritize outreach for maximum impact on quality outcomes.
- Conduct or support clinical outreach to patients with complex or chronic conditions, providing nursing-level guidance on preventive care, medication adherence, and follow-up appointments to close quality measure gaps.
- Support transitions of care initiatives by reviewing discharge summaries, identifying patients at risk for readmission, and coordinating follow-up with outpatient care teams to reduce avoidable readmissions and complications.
- Maintain organized records of care coordination activities, clinical outreach, follow-up actions, and outcomes across joint venture entities.
Meeting Coordination & Administrative Support
- Coordinate and prepare materials for quality meetings, performance reviews, and joint venture leadership presentations, including agendas, data summaries, and follow-up action items.
- Maintain organized documentation of meeting minutes, governance decisions, performance records, and compliance activities across the JV portfolio.
- Support the onboarding of new joint venture programs by assisting with data setup, reporting infrastructure, and workflow integration.
Compliance & Audit Support
- Assist in maintaining audit-ready documentation for regulatory and payer reviews, ensuring quality and performance records are complete and accessible.
- Apply clinical knowledge to review and validate the accuracy of quality measure documentation during audit preparation, identifying and correcting clinical discrepancies prior to submission.
- Support the development of Plans of Correction (POC) by compiling data, tracking corrective action progress, and documenting outcomes.
- Ensure data abstraction and reporting activities align with HIPAA privacy standards, CMS program requirements, and joint venture governance policies.
Qualifications
Education:
Associate's or Bachelor's degree in Nursing required. Bachelor of Science in Nursing (BSN) preferred.
Licensure:
Current, unrestricted Registered Nurse (RN) license in the state of Indiana required.
Experience:
2+ years of clinical nursing experience required, with preference for experience in ambulatory care, care management, or quality improvement settings. Experience in an ACO, value-based care, or joint venture environment is a plus. Familiarity with CMS quality programs, HEDIS/Stars measures, or HCC risk adjustment preferred.
Technical Skills:
- Proficiency in Electronic Health Records (EHR) systems with ability to navigate and interpret clinical documentation.
- Experience with data visualization or reporting platforms such as PowerBI, Tableau, or Excel.
- Strong attention to detail with demonstrated ability to manage and validate clinical data sets accurately.
Knowledge Areas:
- Working knowledge of CMS regulations, value-based payment models, and quality reporting requirements.
- Familiarity with Stars quality measures, care gap closure processes, and chronic disease management standards.
- Understanding of HIPAA privacy standards, healthcare data governance practices, and clinical documentation requirements.
- Strong clinical assessment skills with ability to evaluate patient records, identify care gaps, and communicate findings effectively to physicians and multidisciplinary care teams.
Scope & Impact
- Supports quality performance across all joint ventures within the Deaconess Health System portfolio, bringing clinical depth to data analysis and care improvement efforts.
- Contributes directly to CMS Star Ratings, shared savings performance, and regulatory compliance through clinically accurate data abstraction, meaningful provider engagement, and targeted care gap closure.
- Reports to the Quality Program Supervisor of Joint Ventures; collaborates with physicians, clinical staff, and operational leaders across joint venture entities.
- Plays a key role in building scalable, clinically informed quality infrastructure to support the continued growth and performance of the JV portfolio.