Job details
Job type full-time
Full job description
The quality nurse audito r is responsible for receiving, extracting, reviewing, and documenting clinical information from a member’s medical record that supports the quality improvement/ hedis/stars division measures and goals.
The auditor utilizes clinical knowledge and technical specifications review documentation and files from medical records that align with cms, and other governing agency, clinical quality metricsThe staff nurse is responsibility for ensuring and maintaining the mission of peoples health as outlined in the mission statement.
You’ll enjoy the flexibility to telecommute* from within the state of louisiana as you take on some tough challenges.
Principal responsibilities:
Improve health care quality and increase likelihood of desired health outcomes
Monitors performance against assigned member’s gaps in hedis and star measures through weekly report analysis
Contacts provider offices to obtain necessary medical records to identify and close member gaps in care
Implements interventions designed to improve health outcomes specific to measures and quality improvement projects
Retrieves data from audits; reviews and updates compliance with hedis and cms metrics within the member file
Performs provider and/or facility surveys and audits to review medical records and update member file
Prevent hospital readmission
Prepares quality documentation of requests and determinations that may ultimately prevent hospital readmission including but not limited too
Record review to ensure medication reconciliation is timely
Record review to ensure pcp has been notified timely of admission and discharge information
Implement activities to improve patient safety and reduce medical errors
Participates in provider office site reviews to ensure facility meets safety and quality standards
Reviews medical record documentation to ensure compliance with evidence- based clinical practice guidelines
Reports any issues identified through medical record review to qi director and quality referral nurse
Provide and support wellness and health promotion activities
Interacts with the member and the multidisciplinary team to establish measurable health care goals and prioritization of the member’s needs
Support health information technology (hit) in health care quality improvement
Works in coordination company-based security health information systems technology to ensure appropriate documentation of the member’s care coordination and record
Participates in ongoing training to ensure the records are accurate and secure
Follows corporate instruction based on federal and state guidance related to health information documentation and security
Other
Works within company and program standards and timelines
Peoples health competencies:
Commitment: to our members: we have the power to change our member’s lives by placing them at the center of everything we do daily
Action: by working together and delivering quality service, we enhance the lives of our members through dedication and teamwork
Responsibility: to continue to strive to be the best for our members by adapting and evolving to change, continuing professional development, and to never stop learning
Excellence: by exceeding expectations and finding innovative ways to exceed standards, we are changing our members’ lives
Core competencies
Ability to:
Access clinical data and draw conclusions
Think critically
Influence and effect change utilizing negotiation, conflict management and resolution skills
Interview, assess and develop effective individualized care plans
Utilize effective means of both oral and written communication in order to gain members’ comprehension of encounter
Utilize sound clinical judgement, assessment, planning and care coordination skills
Be professional by being prompt, dependable and prepared
Be a team player and to collaborate and work effectively with team members by displaying a helpful, pleasant and positive attitude and a willingness to adapt to change
Comprehend and adhere to policies and procedures
Utilize time management skills efficiently and effectively in order to handle multiple demands of diverse workload, organize and prioritize critical issues in order to meet daily deadlines
Read, comprehend both written and oral communications and apply the information at hand
Work independently and pro-actively and carry-out assignments to completion with minimum assistance
Perform accurate work with a strong attention to detail
Appreciate the diversity of work styles
Display a high level of integrity and respect for confidentiality and adhere to regulatory and ph policies and procedures
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required qualifications:
High school diploma or ged
Licensed practical nurse in the state of la
3 years’ experience in clinical or similar setting
3 years’ experience with clinical documentation systems
2 years’ experience working within star program and closing hedis gaps in care
Preferred qualifications:
Previous experience supporting health information technology (hit) in health care quality improvement
Previous experience retrieving data from audits, while reviewing and updating compliance with hedis and cms metrics within a member file
Advanced proficiency in in ms suite; excel, word and outlook
Unitedhealth group requires all new hires and employees to report their covid-19 vaccination status.
Careers at unitedhealthcare medicare & retirementThe boomer generation is the fastest growing market segment in health careAnd we are the largest business in the nation dedicated to serving their unique health and well-being needsUp for the challenge of a lifetime? join a team of the best and the brightest to find bold new ways to proactively improve the health and quality of life of these 9 million customersYou`ll find a wealth of dynamic opportunities to grow and develop as we work together to heal and strengthen our health care systemReady? it`s time to do your life`s best work.(sm)
*all telecommuters will be required to adhere to unitedhealth group`s telecommuter policy
Diversity creates a healthier atmosphere: unitedhealth group is an equal employment opportunity/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
Unitedhealth group is a drug-free workplaceCandidates are required to pass a drug test before beginning employment.
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