Quality Critical Incident Clinical Coordinator

Location Address:

Compensation Pay Range:

Summary:

Responsibilities:

Critical Incident Reporting is a Contractual requirement within the State of New Mexico and Presbyterian Health Plan Medicaid Contract. Critical Incidents include but are not limited to reports of abuse, neglect, and exploitation towards a Member. This Registered Nurse position is responsible for the coordination of a variety of aspects of the Critical Incident Reporting process, initiatives and specialized program activities with minimal oversight and independent judgement. Responsible for processing of daily assignment of Critical Incidents timely and accurately to ensure Members healthcare and safety needs are met and contractual timelines are met.

Some key responsibilities include:

• Under the supervision of Critical Incident Management RN Supervisor, this position is responsible for applying clinical judgement to Critical Incident Reports.
• Completes daily processing of incoming Critical Incidents on the NM CIR Portal and refers all Critical Incidents for appropriate follow up activities with Care Coordination, Providers, Adult Protective Services, Children Youth and Families Department, and/or other quality workflows as needed.
• Documents all pertinent Critical Incident data and information in the PHP internal database.
• Upon gained knowledge and expertise will process more complex Critical Incidents.
• Collaborates with the Quality of Clinical Care (QOCC) Team to identify and refer appropriate referrals from CIR for QOC investigation.
• Actively participates and collaborates with the CIR team in routine team and department meetings to identify issues, trends, best practices, and process improvement activities.
• Performs other duties as assigned.

Qualifications:

• Asociates Degree Required
• Current New Mexico RN License required.
• Three to five years experience in clinical nursing field required, three years quality improvement experience preferred.
• Demonstrated ability to apply
• Nursing judgement to complex member situations. Knowledge of case management and care coordination concepts and activities preferred.
• Excellent written, oral, and facilitation skills required.
• Proficiency in Microsoft in Word, Excel, and Outlook required. Demonstrates ability to work with highly sensitive and confidential information.

All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.

Wellness
Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.

Why work at Presbyterian?
As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.

About Presbyterian Healthcare Services
Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.