JOB PURPOSE
The incumbent will be responsible for ensuring the quality of healthcare services through carrying out reviews, coordination of team members, identifying and addressing deficiencies as well as preparing reports.
KEY DUTIES AND RESPONSIBILITIES
Review Nurses notes documents for accuracy and completeness prior to locking and submitting data electronically. Return any incomplete or incorrect notes for review.
Reviews physician orders, medication profiles, aide care plans in relation to the nurses’ notes QA.
Review all Medicaid and other episodic payers’ clinical records at the local level to assure appropriate documentation for reimbursement. This review includes verification of appropriate documentation, quality of care provided, visits utilization, appropriate contacts with physicians, adherence to the care plan, and evidence of communication between disciplines.
Review Nurse’s notes for accuracy and completeness following the plan of care prior to approval.
Coordinate communication between team members/attending physicians/caregivers to ensure the appropriateness of care and outcome planning and ensure compliance through review of documentation and care coordination activities.
Participate in performance improvement activities, maintain ongoing clinical knowledge through internal/external training programs, provide interpretation of knowledge and direction to staff.
Identify clinical problem areas and document deficiency trends in a proactive approach.
Educate administrative and clinical associate staff in the correction of these deficiencies.
Participate in biweekly meetings and report ongoing issues in the QA /Clinical departments.
Submit weekly reports for QA including how many notes QA’d within the week, identify ongoing issues that require further review.
Other duties as assigned.
MINIMUM QUALIFICATION AND EXPERIENCE
University degree in Nursing or any other medical related field.
Minimum of (5) years of experience as a professional nurse.
Currently, licensed and “in good standing.”
Familiarity with ERP systems is required.
Excellent analytical skills using Microsoft Excel.
SKILLS
Quick learner with the ability to adapt to changing environments.
Strong team player, collaborating effectively with colleagues.
Ability to prioritize job tasks and multitask functions.
Creative problem solver with a strong attention to detail.
Must have superb interpersonal and organizational skills with proven ability to work independently and in a team setting.
Strong ability to apply common sense understanding, judgment, and leadership to carry out instructions furnished in written, oral, or diagram form.
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