Job Description

Title: Quality Management Clinical Analyst

Responsible to: Director Quality Management

1. 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. 

2. Medicare expedited appeals. Review case, writes detailed notice, ensures all information is sent to the QIO.

3. Conducts quarterly utilization review including the preparation of the UR report for UR Committee and Professional Advisory Committee (PAC) presentation.

4. Infection reporting and infection control: Investigation, record review, writing infection reports, collating and reporting data to PAC.

5. 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.

6. 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.

7. 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.

8. Assists QM Director/Compliance Officer with complaint and other investigations as requested including review of patient record.

9. Vendor Management: conducts personnel file audits and policy review of new vendors to ensure that vendor meet Agency standards.

Experience: At least 2 years’ CHHA experience preferably in a quality assurance role.

Education: RN, BSN preferred.

Technical Skills: Word, Excel, PowerPoint