Sign-on Bonus and Relocation Reimbursement available!

Receive 17% weekday nights, 26% weekend nights, or 15% weekend day shift differentials!

Department: Trauma Support
FTE: 1.00
Full Time
Shift: Days

Position Summary:
Coordinates, monitors, promotes and evaluates, in collaboration with the Trauma Medical Director the clinical aspects of the Trauma program to ensure quality trauma patient care is provided through performance improvement, practice and education in collaboration with the Trauma team to include medical and administrative directors. Responsible for the coordination of the Trauma Program Performance Improvement (PI) activities. Promotes interdisciplinary collaboration, and champions a service of excellence. Serves as a liaison and consultant with interdisciplinary teams for optimal care of the trauma patient. Works collaboratively to ensure patient needs are met and appropriate care delivery is coordinated across the continuum at the proper level of care. Successfully integrates a collaborative Care Team approach to care, that focuses on the patient, to assure discharge-planning needs are met, achieve desire quality patient outcomes. These duties and responsibilities are mandated by the American College of Surgeons (ACS) for Level I Trauma designation and verification. Assures compliance with standards, policies and requirements of governmental/regulatory agencies and professional organizations under the supervision of the Trauma Program Director. Ensures adherence to Hospitals and departmental policies and procedures. No patient care assignment.

Detailed responsibilities:
* COORDINATE - Coordinates the Trauma Program Performance Improvement daily activities such as identifying and reviewing potential outliers in collaboration with the Trauma Medical Director. These activities include but are not limited to monthly: Multidisciplinary Quality Improvement (MDQI) Committee, Trauma Case Review/Peer Review Committee, Trauma Performance Improvement Committee (TPIC), Trauma Mortality & Morbidity (M&M) Conference, Medical Peer Review (MPR) Committee, Trauma Grand Rounds Conference, ACS Trauma Quality Improvement Program (TQIP) initiatives
* REPORTS - Completes trauma performance improvement reports for MDQI and TPIC on a monthly basis, as well as PI focused reviews as requested by the Trauma Medical Director; enters PI process data into the Trauma Registry
* METRICS - Tracks and trends PI indicators within a timely manner, according to established policies, procedures, and guidelines; confers with the Trauma Medical Director and the Trauma Program Director regarding PI issues and interpretation of trauma care standards of practice
* PROCESS IMPROVEMENT - Actively participates in the development, implementation, and evaluation of corrective actions for identified opportunities for improvement; develops action plans for these PI initiatives, evaluates, and reports on implementation outcomes
* CONSULT - Oversees clinical activities, and functions as consultant to colleagues and other health care providers on quality of care and trauma performance improvement
* OUTCOMES - Monitors intra-hospital, as well as inter-hospital, patient transfers and outcomes
* EDUCATION - Collaborates with the Trauma Medical Director and medical staff in identifying educational needs of trauma service personnel and in matters related to patient care issues and opportunities for improvement
* MEETINGS - Attends daily trauma sign out, daily clinical reviews on high risk trauma patients and as needed for the general trauma patient population
* IDENTIFY - Identify and record principle diagnoses and procedures for standards of care; presents results of individual teaching case reviews to the attending physician(s) and/or department or division members
* CONCURRENT REVIEW - Conducts initial concurrent review and ongoing re-reviews for all selected admissions to initiate the tracking process, documents findings in the Trauma Registry, and identifies other key quality indicators as appropriate
* DOCUMENTATION - Identifies the need to clarify documentation in medical records and initiate communication with physician, nurse, or patient care coordinator by utilizing the appropriate "query" tools in order to capture the documentation in the medical record that accurately supports the patient's severity of illness
* INTERPRET - Interprets clinical information in the medical record, evaluate medications, vital signs, surgical outcomes, etc. Identify potential diagnoses based on this information and communicate with physicians to obtain appropriate documentation that most accurately reflects patient severity, risk of mortality, length of stay
* MONITOR - Utilizes monitoring tools to track the progress of the Documentation Improvement Program and identified quality indicator tracking elements, interpret tracking information and reports findings to the MDQI, TCR, and TPIC meetings. Identifies department and/or specialty trends and patterns that show opportunities for improvements in documentations
* ROUNDING - Participates in clinical rounding and other communication with physicians and residents on the inpatient units to obtain/clarify specific principal diagnoses or comorbidities and complications that pertain to the clinical information shared on specific patients during rounding; assists the rounding team with clarification of documentation appropriate that identifies diagnoses vs. ill-defined clinical symptoms; facilitates assertive, tactful communication when encountering resistance due to perception that information is adequately documented to achieve complete documentation per coding guidelines
* COORDINATE - Coordinates and facilitate communication between Health Information Management, Utilization Review/Case management, Quality Management, physician leadership to acquire, interpret, and transmit accurate diagnostic and procedure documentation; establishes good working relationships with department Chairs and department Administrators to improve documentation
* ANALYZE - Analyzes baseline outcomes; develop process improvement plans to improve baseline to a higher level of performance; prioritize and implement process improvement action plans; monitor results, and present results in a way to capture provider interest and motivate change in documentation practices
* REPORTS - Creates appropriate reports to demonstrate improvements in major complication and comorbidity (MCC) and/or complication and comorbidity (CC) capture rates; use report analysis to demonstrate missed opportunities to appropriate capture the true severity of illness patients
* TRAINING - Uses query statistics and query type information to create training materials for physicians and ancillary staff ; identify opportunities for physician education to improve medical record documentation for severity of illness on an ongoing basis
* CONFIDENTIALTY - Maintains confidentiality of patient records
* TRAUMA REGISTRY - Responsible for trauma registry inter-rater reliability

Qualifications

Education:
Essential:
* Bachelor's Degree
Nonessential:
* Master's Degree
Education specialization:
Essential:
* Nursing
Nonessential:
* Related Discipline

Experience:
Essential:
1 year directly related experience
Nonessential:
No preferred experience

Credentials:
Essential:
* RN in NM or as allowed by reciprocal agreement by NM
Nonessential:
* Certified Coding Specialist
* Cert Doc Imp Prac/Spec (CDIP or CDIS) or Cert Coding Spec

Physical Conditions:
Sedentary Work: Exerting up to 10 pounds of force occasionally (Occasionally: activity or condition exists up to 1/3 of the time) and/or a negligible amount of force frequently (Frequently: activity or condition exists from 1/3 to 2/3 of the time) to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

Working conditions:
Essential:
* Minor Hazard - physical risks, dirt, dust, fumes, noise

Department: Registered Nurse