Program Coordinator – Ambulatory Quality & Cancer/PCMH Accreditation

About the role

This position requires a licensed nurse with demonstrated leadership experience to provide clinical oversight, program coordination, and quality management across ambulatory oncology and specialty services. Cancer experience is preferred.

Responsibilities

• Serve as the designated operational lead for the Commission on Cancer program for Nashville General Hospital ambulatory practices.
• Coordinate all activities required to achieve, maintain, and enhance CoC accreditation status.
• Ensure all program activities, evidence, and documentation comply with CoC standards.
• Interpret CoC standards and translate requirements into actionable workplans for clinical and administrative teams.
• Prepare for surveys, site visits, mock reviews, annual submissions, and reaccreditation cycles.
• Facilitate Cancer Committee and multidisciplinary Cancer Conference meetings, including agendas, minutes, attendance, CME documentation, follow-up actions, and case coordination.
• Coordinate with physicians to identify cases for conference presentation and track care recommendations discussed during conferences.
• Manage all CoC standard data reporting, quality studies, dashboards, and required submissions.
• Partner with the Cancer Registrar to monitor follow-up metrics, concordance reviews, and required corrective actions.
• Collaborate with the Cancer Liaison Physician (CLP) to implement, track, and report quality initiatives.
• Coordinate with research staff to support clinical trial screening, enrollment goals, and program compliance metrics.
• Lead community outreach, survivorship, screening, and prevention activities in collaboration with community partners.
• Serve as liaison with the American Cancer Society, Tennessee Cancer Coalition, and state cancer registry partners.
• Maintain ongoing readiness status and serve as subject matter expert for CoC requirements.
• Coordinate activities supporting NCQA Patient-Centered Medical Home (PCMH) recognition for ambulatory primary care practices.
• Maintain documentation, evidence files, workflows, and policies required for PCMH recognition.
• Collaborate with practice leadership to improve access, care management, population health, patient experience, and team-based care processes.
• Monitor PCMH performance measures, readiness timelines, and re-certification milestones.
• Lead quality improvement initiatives across primary care, multispecialty, oncology, infusion, renal, and endoscopy service lines.
• Identify operational gaps in clinic flow, patient throughput, scheduling, access, and coordination; implement process improvement plans.
• Develop and maintain scorecards for quality, patient safety, access, throughput, patient satisfaction, and regulatory performance.
• Facilitate root cause analyses, workflow redesign, and performance improvement projects.
• Coordinate Joint Commission readiness activities, mock tracers, surveillance rounds, corrective actions, and staff education.
• Audit clinical documentation and workflows for Joint Commission and CoC compliance.
• Develop EMR templates, clinical tools, and documentation standards to support regulatory compliance and efficient operations.
• Support referral management, continuity of care, prior authorizations, and transitions of care as operationally needed.
• Review reimbursement denials related to medications or infusion services in collaboration with revenue cycle and pharmacy.
• Provide advanced oncology nursing guidance and clinical leadership for ambulatory oncology services and related specialty programs.
• Support staff competency validation, orientation, annual skills review, and ongoing professional development.
• Coordinate education for new therapeutic agents, biologics, and evolving treatment protocols.
• Train and mentor nursing staff on complex clinical procedures including vascular access care, ostomy care, phlebotomy, infusion therapies, and related ambulatory procedures.
• Support chemotherapy competency programs, administration standards, handling, and disposal policies in partnership with pharmacy and environmental services.
• Provide clinical support and staffing coverage during critical shortages or operational disruptions, including nursing and clinic support roles as appropriate.
• Aid in patient symptom triage, care coordination, prescription refill workflows, and urgent clinical concerns.
• Coordinate interdisciplinary care plans and transitions across inpatient, outpatient, and specialty settings.
• Assist with departmental budgeting, staffing plans, productivity monitoring, contracts, and expense management related to cancer program and ambulatory specialty operations.
• Support hiring, onboarding, coaching, performance evaluations, and corrective action processes consistent with hospital policy.
• Maintain vendor credentialing, specialty drug program enrollment, REMS compliance activities, and applicable external program requirements.
• Prepare executive reports, dashboards, presentations, and strategic updates for leadership.

Qualifications

• Associate or Bachelor of Science in Nursing required; Bachelor of Science in Nursing preferred.
• Current unrestricted Registered Nurse (RN) license in the State of Tennessee required.
• Master’s degree in Nursing, Healthcare Administration, Public Health, or related field preferred.
• Minimum 5 years of nursing experience required.
• Minimum 3 years of leadership, program management, quality, or ambulatory operations experience preferred.
• Oncology or cancer program experience preferred.
• Experience with Commission on Cancer standards strongly preferred.
• Experience with NCQA PCMH recognition preferred.

Knowledge, Skills, And Abilities

• Strong knowledge of ambulatory nursing operations, oncology workflows, accreditation, and regulatory frameworks.
• Expertise in quality improvement methodologies (Lean, PDSA, RCA, Six Sigma).
• Strong leadership, communication, and project management skills.
• Ability to analyze data and drive measurable outcomes.
• Ability to manage multiple priorities while maintaining focus on CoC program success as the primary responsibility.