Fallon Health

Returning Candidate?

Quality Nurse

Quality Nurse

Job ID 
# Positions 
Posted Date 

More information about this job


About Fallon Health:

Founded in 1977, Fallon Health is a leading health care services organization that supports the diverse and changing needs of those we serve. In addition to offering innovative health insurance solutions and a variety of Medicaid and Medicare products, we excel in creating unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs. Fallon has consistently ranked among the nation’s top health plans, and is accredited by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit www.fallonhealth.org.


About Summit ElderCare:

Fallon Health operates the largest Program of All-Inclusive Care for the Elderly (PACE) in New England and the fifth largest in the country. Called Summit ElderCare, Fallon’s PACE helps provide older adults and their caregivers with a welcome alternative to nursing home care. Participants in Summit ElderCare have access to comprehensive medical services and social support at a Summit ElderCare site while they keep the independence of living in their own homes and communities.


Position Overview:

 The Clinical Quality Nurse is accountable for the reporting of clinical quality data, data collection, and data analysis.  Projects may include medical record data abstraction, quality of care reviews, grievance and incident investigation or quality initiatives.  This role provides clinical expertise, technical support and data analysis for departmental initiatives and the Quality Services program structure. 


  • Perform case reviews on medical records to identify quality of care or substandard care referred from incident reports, grievances, etc. 
  • Assist in the planning, organization and direction of the quality assessment performance improvement  program and related activities.
  • Assist in the evaluation of programs and implements changes as necessary to improve programs and assure compliance with regulatory requirements.
  • Provide support with administrative functions such as form completion, writing reports, and submissions to management and/or appropriate agencies as required.
  • Assist in the investigation of incidents, injuries, abuse, etc.  Summarize findings and file reports to appropriate staff and agencies
  • Oversee  maintenance of  clinical logs to manage data that supports clinical quality improvement, activities HPMS reporting and other external reporting requirements.Analyse clinical tracking logs and monitor for patterns and trends requiring corrective actions.
  • Assist in developing annual auditing schedules for departments as well as audit development when identified.
  • Coordinate studies performed within the quality assessment performance improvement  program and prepares reports  as required.
  • Assist in the development and delivery of educational programs revolving around all components of quality assessment performance improvement, including orientation for employees and programs to address the quality assessment process and regulatory guidelines.

  • Assist PACE organization sites in developing indicators and follow up procedures for identified problems

  • Other duties as necessary


Education: Degree in nursing (Baccalaureate preferred) with a current MA nursing license


License: RN




5 years elated experience in a healthcare setting preferably with a geriatric population

Quality management/ performance improvement experience preferred

Knowledge of quality assessment and performance improvement  procedures