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Good Samaritan · 2 months ago

Clinical Quality Assurance Specialist- SF Center- PT Day

Sioux Falls, SD

Part-time

Onsite

Senior Level

$24/hr - $38.50/hr

5+ years exp

Good Samaritan is a not-for-profit organization that has been providing housing and services to seniors for over 100 years. They are seeking a Clinical Quality Assurance Specialist to manage clinical, operational, and managerial activities, focusing on quality risk and improvement programs while collaborating with various departments to ensure workflow completion.

Health CareNon ProfitRehabilitation

Responsibilities

Perform necessary delegation and coordination of clinical, operational and managerial activities to accomplish the objectives of the assigned area(s) of nursing

Incorporate responsibilities related to the quality risk and risk score adjustment programs

Assist with the quality improvement review and audit related to potential quality risk issues and adverse events as part of the quality risk program

Complete chart reviews, documentation of findings, referral for medical director review and required reporting

Perform healthcare effectiveness data and information set (HEDIS) record reviews and assist with clinical questions related to chart reviews

Work collaboratively with internal and external departments to ensure all aspects of workflow are completed

Review the risk score adjustment information for medical chart record requests and potential medical chart review

Manage the chart review process by reviewing the record request list, collaborating with information technology (IT) for file accuracy, coordinating the record requests with providers or vendors and collaborating with the chart review vendor, if applicable

Review the medical visit file to determine individuals requiring outreach to coordinate medical services

Assist members in the coordination of appointments for services

Complete tracking documentation of medical record requests, chart reviews and medical visit appointments to ensure status is current

Act as a liaison for accrediting or governing agencies for services such as sleep medicine

Qualification

RN licenseQuality improvementRisk adjustmentMedical codingAccreditation standardsMulti-taskingComputer proficiencyCritical thinkingProblem solvingCollaboration

Required

Graduate from a nationally accredited nursing program

Minimum of five years of nursing experience

Currently holds an unencumbered RN license with the State Board of Nursing where the practice of nursing is occurring and/or possess multistate licensure if in a Nurse Licensure Compact (NLC) state

Obtains and subsequently maintains required department specific competencies and certifications

Must be analytical and have critical thinking, problem solving and decision making skills

Must be organized and able to multi-task

Must be proficient in computer software such as Word and Excel