Nursing - Quality Auditor/ RN/ LPN
Responsibilities :
- Conduct on-site reviews at participating provider offices to assess environment, quality of physicians' medical records, and compliance with documentation standards.
- Prepare documentation summarizing on-site findings with physicians, providing education and discussing opportunities for improvement.
- Provide data support services to analyze trends / patterns for quality improvement and health management.
- Assist the Quality Management department with special projects and focused clinical studies.
- Perform related tasks or special studies as requested.
- Assist in training internal staff, providers, and vendors on programs and audit standards.
- Serve as an in-house representative and project lead for state audits.
- Analyze audit findings and produce various reports as requested.
- Coordinate and manage the Corrective Action Plan (CAP) process for assigned audit types.
- Conduct reaudits to ensure prior deficiencies were addressed.
Education Qualification :
- Requires three to five years of related business experience, preferably in the healthcare industry.
- Requires a License Practical Nurse License or an active New Jersey Registered Nurse License.
Required Skills :
- Knowledge of managed care principles and medical terminology.
- Proficiency in PC's and related software.
- Preferably familiar with URAC accreditation standards and HEDIS principles.
- Excellent verbal and written communication skills.
- Strong organization, analytical, problem-solving, conflict resolution, and decision-making skills.
- Proficient in PC skills and presentation skills.
There is available for relocation.
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