Position Purpose: The Clinical Quality Assurance RN will work in various capacities to review, monitor and train staff in the Long Term Care Department. Potentially working to review care management activities/records of the Care Management Teams and/or activities / clinical documentation submitted by the Intake Specialist. The Clinical Quality Assurance RN will review for to confirm accuracy and monitor timeliness in accordance with the Fidelis Care’s policies and regulatory standards, ensuring adherence to departmental and regulatory data integrity standards and requirements including contractual obligations with State and Federal agencies such as New York State Department of Health (NYDOH), County Department of Health (CDOH), Local Department of Social Services and Center for Medicare & Medicaid Services (CMS). The Clinical Quality Assurance RN will also create, analyze, report and maintain metrics and processes in support of the department and all relevant NYS programs and product lines. The Clinical Quality Assurance RN will ensure that their findings are summarized and reported to applicable management and take the specific focus/emphasis of relaying finding directly to staff and partnering with management to directly train and retrain staff. The Clinical Quality Assurance RN will take ownership to ensure staff members reach a level of competence in their assigned role and will devise individual plans in assisting staff in reaching the desired level of performance. The Clinical Quality Assurance RN will spend time in the field while reviewing Intake Specialist work and will actively coach and develop staff with real-time training and real-time feedback.
License/Certification: Active NY RN License.
Education/Experience: BA/BS - Bachelors Degree or equivalent required. Knowledge of Department of Health (DOH) and Local Department of Social Services and Center for Medicare & Medicaid Services (CMS regulations). Working in a home care environment or as a staff nurse in an acute, sub-acute or long-term care (LTC) setting or managed long-term care plan (MLTCP); Geriatrics, Medical Surgical Nursing, Case Management or Discharge Planning. Certification courses or other higher education in nursing, healthcare administration, business, operations management or other related discipline. Proficiency with healthcare terminology such as ICD 10 codes, medical abbreviations, medications. Experience in medical records review, claims processing or utilization and case management in a clinical practice or managed care organization. Experience analyzing various types of data and processes in a versatile manner including ability to present findings and make recommendations. Microsoft Excel skills with the ability to edit, search, sort/filter, format/use styles, create tables, calculate data using functions and formulas and create/use PivotTables for analyzing data.
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