Clinical Quality Compliance Auditor RN, Full Time, Day Shift

Job Summary

The Clinical Quality Compliance Auditor RN’s overall purpose is to ensure that Summit Healthcare meets the highest standards of patient care, safety, and compliance with regulatory requirements. This position will assist in the implementation and reporting of quality improvement initiatives at the federal, state and local level. The position requires a strong background in quality assurance, patient record review, abstraction and data analysis. It is essential that the Clinical Quality Compliance Auditor RN has a strong attention to detail, a proactive mindset and the ability to manage multiple priorities and deadlines.

Essential Functions

- Assists with compliance in regulatory standards and accreditation requirements.

- Provides in-depth reviews of patient charts and abstracting data to facilitate mandated reporting requirements for federal, state and local quality programs (IPPS, OPPS, DAP, JC, HealthII).

- Assists with Center for Medicare and Medicaid Services (CMS) and state continuous readiness through review of recent changes.

- Develops and implements quality improvement initiatives to enhance patient care and safety.

- Ensures data entry completion for required regulatory reporting agencies.

- Collaborates with healthcare teams to design and execute process improvement strategies and programs.

- Analyzes data, generates reports and tracks performance improvement on quality goals and indicators.

- Conducts regular audits and assessments to evaluate the effectiveness of quality programs.

- Provides education to hospital staff and medical staff on current and upcoming quality initiatives.

- Stays updated on industry trends and advancements in healthcare quality management.

- Promotes a culture of patient safety, quality and continuous improvement and ensures staff adhere to Summit Healthcare’s Patient Safety Program and plan.

- Completes other duties as assigned to fulfill Summit Healthcare’s Quality Management initiatives and strategic goals.

Other Duties

- Participates in departmental and association wide informational meetings and inservices, including staff meetings, association wide forums, and seminars.

- Reviews department and association wide policies and procedures annually. Develops and maintains new policies and procedures as needed.

Duties, responsibilities and activities may change or new ones may be assigned at any time with or without notice.

Abilities

- Proven experience in medical record review, abstraction and reporting.

- Familiarity with healthcare regulations and accreditation standards.

- Proficiency in data analysis and reporting tools.

- Proficiency with medical terminology, coding systems and electronic health records.

- Excellent analytical and problem-solving skills.

- Strong knowledge of quality improvement methodologies.

- Ability to lead and motivate multidisciplinary teams.

- Proficiency with medical terminology, coding systems and electronic health records.

- Effective oral, written and presentation skills

- This position requires knowledge of general office equipment (including the nurse call system, telephone system, fax machine, copy machine, computer, and commonly used hospital programs).

- This position also requires knowledge of hospital equipment and programs, including all Hospital Information Systems and department specific equipment.

- Must read, write, speak, and understand English.

Supervisory Responsibilities

- None

Work Environment

At Summit Healthcare, our mission statement is that we are trusted to provide exceptional, compassionate care close to home. Our vision is to be the healthcare system of choice.

To uphold our mission and vision statements, we expect all employees to practice SHINE Behavioral standards:

- Always SHINE – show respect and be kind.

- Always work together – we are on the same team.

- Always serve others – no job is beneath you.

- Always maintain high standards of quality and safety – best practice every time.

- Always communicate clearly – be compassionate.

- Always practice integrity – maintain confidentiality.

- Always be accountable – take responsibility.

- Always empower – create an environment of success.

- Always excel – don’t settle for mediocrity.

- Always promote wellness – make choices for a healthy lifestyle.

Physical Demands

Exerts up to 10 lbs. of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Involves sitting most of the time, but may involve walking or standing for brief periods of time.

Required Education and Experience

- Current AZ nursing license in good standing.

- Bachelor’s degree in nursing.

- Minimum 5 years’ experience as an RN.

- Minimum 1 - 3 years’ clinical leadership experience or as a clinical professional.

Preferred Education and Experience

- Certified Professional in Healthcare Quality (CPHQ), Lean Six Sigma or other accredited healthcare quality improvement certification.

- Master’s degree in public health, healthcare administration or nursing.

- Minimum of 1-3 years’ experience of quality/process improvement/clinical documentation and coding experience in a healthcare setting.

OSHA Exposure Category:

Involves no regular exposure to blood, body fluids, or tissues, and tasks that involve exposure to blood, body fluids, or tissues and are not a condition of employment.

This is a safety sensitive position.