Quality Management Clinical Analyst
2 weeks ago
**Responsibilities**:
- Incident reporting: logging, investigation, ensures written report on file, assists clinical managers with written reports, collates information on a quarterly basis. Provides education to clinical staff regarding risk management and incident reporting.
- Medicare expedited appeals. Review case, writes detailed notice, ensures all information is sent to the QIO.
- Conducts quarterly utilization review including the preparation of the UR report for UR Committee and Professional Advisory Committee (PAC) presentation.
- Infection reporting and infection control: Investigation, record review, writing infection reports, collating and reporting data to PAC.
- Medical record requests: oversight of QM Assistant with processing medical record requests to ensure timely distribution, audit of the record prior to distribution to the requestor.
- Potentially Avoidable Events (PAE): review OASIS PAE reports and conducts record audit of patient experiencing potentially avoidable events to determine agency risk in the event occurrence; prepares PAE report for PAC presentation. Provides feedback to clinical management on deficiencies found.
- Focused record audits related to problem prone areas, performance improvement projects and plans of correction on an as needed basis. Provides feedback to clinical management on deficiencies.
- Assists QM Director/Compliance Officer with complaint and other investigations as requested including review of patient record.
- Vendor Management: conducts personnel file audits and policy review of new vendors to ensure that vendor meet Agency standards.
Job Qualifications Required
- At least 2 years’ CHHA experience preferably in a quality assurance role.
Education, Knowledge, Skills and Abilities Preferred
- RN, BSN preferred.
- Word, Excel, Power Point
**Job Type**: Full-time
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