Facility Site Review Nurse Specialist RN II

Job Summary

The Facility Site Review (FSR) Nurse Specialist RN II conducts face-to-face visits with our high-membership physicians to provide feedback, data, and education on programs and facilitates changes to improve quality of care and service to members. Conducts various types of site reviews of Primary Care Physician (PCP) and specialist sites to ensure quality FSR and physician compliance with Local, State, and Federal requirements.  

Duties

Conducts Full Scope Reviews, Site Review Surveys, Medical Record Review Surveys, Specialty Site Review Surveys, physical accessibility review survey (PARS) assessments, Focused Reviews, Interim Onsite Reviews, Consultation/Educational Site visits, Investigative visits, Healthcare Effectiveness Data and Information Set (HEDIS) related visits, and/or other appropriate site visits.

Conducts face-to-face visits with our high-membership physician sites to include the following: Provider feedback to providers on performance on HEDIS-related measures and incentives performance; give providers health education materials and clinical tools to facilitate improved screening, preventive care, and chronic disease management; promote clinical quality improvements in practices; and document outcomes and issues of site visits for review and data gathering to the FSR Manager.

Act as the provider quality improvement liaison (PQIL) to assess and communicate issues and improvement opportunities identified during the physician site visit to the FSR Manager for resolution and a plan of action.  Information gathered from provider sites will be submitted as a report and discussed with the FSR Manager at least bimonthly as appropriate.

Communicates and coordinates information and findings from site visits between FSR Manager, internal and external staff and customers. Documents discussions and correspondence in FSR file as appropriate.

Assists and participates in the facilitation of disease management programs as implemented by the Quality Improvement (QI) department. Assists and participates in the Annual Audit of Plan Partners delegated for FSR.

Perform other duties as assigned.

Duties Continued

Education Required

Education Preferred

Experience

Required:
At least 5-7 year clinical experience including, but not limited to ER/Acute care nursing or outpatient setting.

Preferred: 
Medi-Cal managed care auditing experience.

At least  one (1) year experience in Quality Improvement and  DHCS audit tool.

Skills

Required:
Excellent verbal and written communication skills.

Excellent organizational and time-management skills.

Proficient in Microsoft Office.

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Physical Requirements

Additional Information

Required:

Travel to offsite locations for work.

Must obtain and maintain successful completion of a DHCS Certified Site Reviewer and/or DHCS Certified Trainer certification in order to conduct DHCS accepted audits independently within 6 months of date of hire in the position.

Preferred:
Department of Health Care Services (DHCS) RN Reviewer or Trainer certification.