Registered Nurse -- Performance Improvement

Under the general supervision of the Director of Quality Improvement, the Registered Nurse -- Performance Improvement is responsible for ensuring compliance of assigned providers to federal, state, local, contractual, regulatory, and best practices standards and guidelines.  

PRINCIPAL DUTIES AND RESPONSIBILITIES:

• Conducts Inpatient Hospital Site Reviews.
• Assists with onsite Substance Use Disorder (SUD) Methadone Reviews.
• Conducts reviews of Critical/Sentinel Events to determine if the incident meets the criteria and definitions for a critical event, critical incidents, risk events, sentinel event, or media events and is related to a practice or standard of care. 
• Reviews Critical and Sentinel Events to include analysis and reporting of member experience and satisfaction with services provided allowing for integration with the Customer Experience process.   
• Classifies a critical event or incident as either a) sentinel event, or b) non-sentinel event.
• Develops and updates the "MH-WIN Procedural Guidance Manual for Reporting Critical Incidents/Events, Sentinel Events and Death Reporting Processes".
• Documents and reports high profile, media-reported and urgent incidents that meet the critical incident criteria.
• Develops Critical/Sentinel event face-to-face trainings for the provider network for accessing the Critical/Sentinel Event Module.
• Reports ALL deaths (expected and unexpected) along with the appropriate information to MDHSS within 24 hours of knowledge.
• Processes the closure of assigned deaths in the MH-WIN Module. 
• Reviews investigations of records and information concerning the member including, but not limited to, the review of Individual Plans of Service (IPOS), progress notes, psychiatric evaluations, Behavior Management Plans, records of dispute resolutions, grievances and appeals, and recipient rights complaints.
• Provides follow-up with providers for completion of root cause analysis or investigation; a) the findings shall include actions that will minimize the further occurrence of the sentinel event (per CMS approval and MDHHS current contractual requirement); or b) a written explanation providing the rational for not pursuing an intervention. A corrective action plan or intervention must identify: objective, measurable actions; who will implement the plan of action; a timeframe for the implementation; and how the implementation of the plan will be monitored or evaluated and submitted to DWIHN.
• Maintains all materials as confidential and distributes only as necessary to perform the peer review function.
• Ensures that all information related to the Critical Event is uploaded in MH-WIN using the Critical Event/Sentinel Event Module and placed into the "All Scanned Documents" tab.
• Analyzes data generated by the monitoring programs and identifies opportunities to improve products, processes, and people within the network of care
• Works with the QI Administrator and Director to develop performance improvement targets for quality, service, and efficiency of the organization.  
• Implements changes targeted as systems improvement.  
• Measures and evaluates attainment of results.
• Collaborates with other DWIHN units to ensure communication, teamwork and integration to support achievement of desired improvements.

• Performs related duties as assigned.

   

KNOWLEDGE, SKILLS AND ABILITIES:

• Knowledge of DWIHN policies, procedures, and practices.
• Knowledge of the principals of quality improvement.
• Knowledge of Utilization Management.
• Knowledge of Critical/Sentinel Event policies and procedures.
• Knowledge of Quality Assurance.