QA/Performance Improvement RN

Hybrid Schedule - 3 days Onsite, 2 days Remote!!

Job Summary

The Quality Assurance Registered Nurse (QA RN) supports the PACE organization's data-driven quality assessment and performance improvement program across the full continuum of participant services. The QA RN applies clinical judgment, regulatory knowledge, and improvement methods to evaluate care quality, participant safety, documentation, outcomes, and compliance; identify risk and performance gaps; and coordinate corrective actions that improve and sustain participant care.

Essential Functions

• Support development, implementation, evaluation, and annual review of the PACE quality improvement plan in collaboration with leadership, the interdisciplinary team (IDT), staff, and contracted providers.
• Collect, validate, analyze, trend, and report clinical quality, utilization, safety, service, and participant-experience data; maintain accurate quality dashboards and supporting documentation.
• Use outcome measures and other indicators to identify strong performance, emerging risk, disparities, and opportunities to improve participant care and services.
• Conduct concurrent and retrospective audits of medical records, assessments, care plans, orders, medication management, transitions of care, service delivery, and other assigned clinical processes.
• Review incidents, adverse events, near misses, hospitalizations, emergency department visits, falls, pressure injuries, infections, medication events, and other high-risk occurrences for completeness, timeliness, patterns, and preventability.
• Immediately escalate any identified condition or practice that directly or potentially threatens a participant's health or safety and help coordinate prompt corrective action.
• Facilitate or participate in root cause analyses, case reviews, and performance improvement projects; develop measurable corrective action plans with responsible owners, due dates, and monitoring criteria.
• Verify implementation and effectiveness of corrective actions through follow-up audits, data review, observation, and other validation methods; recommend additional action when improvement is not sustained.
• Prepare quality reports and presentations for quality committees, clinical leadership, executive leadership, and the governing body, as assigned.
• Support accurate and timely quality monitoring and reporting to CMS, the State administering agency, and other oversight bodies in accordance with current requirements and organizational policy.
• Assist with regulatory surveys, CMS or State audits, validation reviews, requests for information, and plans of correction; organize evidence and track findings through closure.
• Review trends involving grievances, appeals, service delivery requests, participant rights, complaints, and satisfaction results in partnership with responsible departments to identify systemic improvement opportunities.
• Develop, review, and update clinical quality policies, procedures, audit tools, workflows, and competency materials to reflect regulatory requirements, evidence-based practice, and organizational standards.
• Educate and coach employees, IDT members, and contracted providers on quality expectations, documentation standards, participant safety, and improvement findings while promoting a just and learning-focused culture.
• Maintain confidentiality and safeguard protected health information in accordance with HIPAA, applicable privacy laws, and organizational policy.
• Participate in committees, workgroups, and special projects and perform other duties within RN scope of practice as assigned.

Education & Experience

• Current, unrestricted Registered Nurse license in the state where services are performed.
• Associate degree or diploma in nursing from an accredited nursing program; Bachelor of Science in Nursing preferred.
• At least three years of professional nursing experience, including experience in quality assurance, performance improvement, utilization review, risk management, clinical auditing, compliance, or a closely related function.
• At least one year of experience working with a frail or older adult population; candidates with less than one year must complete organization-provided training before working independently, consistent with PACE requirements.
• Demonstrated ability to interpret clinical records, regulations, policies, and data and translate findings into practical corrective actions.
• Proficiency with electronic health records, Microsoft Office or equivalent tools, and basic data analysis and reporting.
• Ability to meet organization-established competencies before independent work and all health screening, background screening, and exclusion-check requirements applicable to the position.

Skill Requirements

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Exhibits good organizational skills through effective utilization of staff and resources to achieve departmental goals and objectives

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Displays effective oral and written communication skills to keep supervisors, peers and subordinates informed about progress, problems and related developments.

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Demonstrates working knowledge of all federal, state, local and regulatory agency requirements as related to long term care.

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Evaluates staff in a timely manner to develop individual performance objectives for staff and ensure that competence of staff meets departmental standards.

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Demonstrates the ability to make independent decisions when circumstances warrant such action.

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Demonstrates the ability to deal tactfully with personnel, residents, family members, visitors, government agencies/personnel and general public

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Demonstrates leadership and supervisory ability and the willingness to work harmoniously with and supervise personnel

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Demonstrates the ability to plan, organize, develop, implement and interpret the programs, goals, objectives, policies and procedures that are necessary for providing quality care

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Demonstrates knowledge of Infection Control as it relates to Long Term Care

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Demonstrates the ability to problem solve, communicate effectively and work in group settings.

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Demonstrates the ability to assess the educational needs of facility staff and to provide education to maintain standards of facility.

Functions

• Verify implementation and effectiveness of corrective actions through follow-up audits, data review, observation, and other validation methods; recommend additional action when improvement is not sustained