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Quality Assurance Nurse LTC

Company: Centene Coproration
Location: New York
Posted on: January 17, 2020

Job Description:

Description: 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 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. Review clinical documentation in order to ensure that all components of the Member's medical record are completed with quality standards and accuracy following the Company's policies and State regulations. Maintain a tracking tool that will log unacceptable areas in the workflow and staff documentation performance indicating improvement is needed for discussion with management and/or at departmental team meetings. Conduct monthly one-to-one sessions with Assessment nurses to provide re-education on best practices and clinical documentation. Participate in educational and management meetings to improve clinical core measures and RN quality assessment documentations. Assist with special projects as assigned to meet departmental goals and policies. Act as a liaison between Field Nurses and Nurse Supervisors to improve clinical processes and workflow communication. Assist with gathering data for routine reporting with other team members to be used for day-to-day purposes and at meetings. Assist the Manager, as needed, to determine areas that require immediate remediation and assist Fidelis Care's employees to stay ahead of changing information while improving the quality and effectiveness of documentation being submitted. Participate in training-related projects and identify training sessions that will support staff development as well as assist with the training of new employees. Prepare various reports and correspondences as well as provide summary reports to highlight key findings for implementation of performance improvement plans. Work with colleagues across business units such as Care Management and Regulatory Compliance to ensure that process and procedural changes are reflected in the clinical documentation of the Assessment Nurses' such as job aids and policies.

Keywords: Centene Coproration, New York , Quality Assurance Nurse LTC, Healthcare , New York, New York

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