Providence Health & Services Registered Nurse Coordinator HEDIS Clinical Audit in Beaverton, Oregon
Providence St. Joseph Health is calling a Seasonal Registered Nurse Coordinator HEDIS Clinical Audit to our location in Beaverton, OR. The season Jan-May 2020
We are seeking a Registered Nurse Coordinator HEDIS Clinical Audit to conduct clinical quality audits for the Quality Department. The auditor identifies and coordinates clinical audits to determine potential areas for quality improvement within the PHP network. The audit coordinator collects data by way of chart extraction, using objective specifications for the Healthcare Effectiveness and Data Information Set (HEDIS) program. Audits include review of outpatient medical records, hospital records, clinical lab and pharmacy records. The coordinator is responsible for collecting data based on standardized methodologies and organizes the data to identify and address opportunities for improvement.
This position is an on-call position, and much of the work is seasonal. Individuals in this role will be able to perform chart audits electronically or on site in physician practices during the audit season, which runs approximately February through mid-May. The RN auditor will successfully complete HEDIS training prior to performing chart abstractions. Direction regarding charts require auditing will be provided by staff Clinical QI Coordinator RNs.
The auditor maintains all collected records in a confidential manner and performs all duties in a manner which promotes team concept and reflects the Sisters of Providence mission and philosophy. The RN auditor will communicate in a collaborative manner with clinic and other staff with whom they interact, in a manner that represents Sisters of Providence.
Prioritizing the work to best meet the needs of the multiple stakeholders.
Continuously evaluating processes for improvement.
Maintaining current knowledge and expertise in a rapidly changing environment.
In this position you will have the following responsibilities:
Responsible for the completion of Quality monitoring and chart abstraction audits. Quality audits include but are not limited to: patient health information, clinical testing and follow-up, quality of provider services and medical management, medical record requirements, and other quality requirements as defined by PHP, performance measurement specifications, or Federal and State regulations.
Be able to investigate perceived gaps in care identified through claims in order to identify documentation necessary to support exclusions or numerator hits. Use claims information to track where member has received care.
Adhere to a tight schedule of pre-scheduled clinic visits combined with in-office reviews. Site visits could be at facilities in Oregon or Washington (as RN license supports).
Conduct clinical reviews using medical record/medical information. Use audit tools, conduct auditor training, perform tool validation, and conduct audits. Work with analytical staff to develop and maintain effective databases and reporting. Work with quality team to assure documentation is audit-ready.
Identify concerning care patterns by use of audits and audit reports.
Understand and communicate to practices basic specifications around HEDIS or other clinical measures being audited.
Maintain the confidentiality of all provider and member health data and information. Maintain data integrity with highest degree of accuracy and documentation requirements per PHP's auditor.
Perform Clinical Onsite Provider Record audits to assure and document on a template, appropriate and current standards are in place for access, patient care facilities and medical record standards. Design and compile periodic monitoring reports including program evaluation and identification of improvement opportunities.
Required qualifications for this position include:
Bachelor's Degree in Nursing.
At least 5 years Clinical experience.
Licensed RN in OR and WA.
Preferred qualifications for this position include:
Master's Degree in Nursing.
At least 1 year in Quality management/quality improvement/utilization review auditing experience, including experience in auditing within electronic health records.
Experience with health plans, project management, program evaluation, team facilitation, data analysis, and/or case review.
About the department you will serve.
Providence Strategic and Management Services provides a variety of functional and system support services for all eight regions of Providence Health & Services from Alaska to California. We are focused on supporting our Mission by delivering a robust foundation of services and sharing of specialized expertise.
We offer a full comprehensive range of benefits - see our website for details
As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.
Providence Health & Services is a not-for-profit Catholic network of hospitals, care centers, health plans, physicians, clinics, home health care and services guided by a Mission of caring the Sisters of Providence began over 160 years ago. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
Job Category: Quality Nursing
Req ID: 243595