Sanford Health Clinical Quality Specialist - Administration in Canton, South Dakota

Job Title: Clinical Quality Specialist | Administration | Canton

City: Canton/Inwood

State: South Dakota

Department : ADMINISTRATION

Job Schedule: Full Time

Shift: Days

Hours Per Shift: Other

JOB SUMMARY

Shall be a representative of nursing administration and shall perform necessary delegation and coordination of clinical, operational and managerial activities to accomplish the objectives of the assigned area(s) of nursing. Will incorporate responsibilities related to the quality risk and risk score adjustment programs. Assist with the quality improvement review and audit related to potential quality risk issues and adverse events as part of the quality risk program. Will complete chart reviews, documentation of findings, referral for medical director review and required reporting. Will perform healthcare effectiveness data and information set (HEDIS) record reviews and assist with clinical questions related to chart reviews. Must work collaboratively with internal and external departments to ensure all aspects of workflow are completed. Will review the risk score adjustment information for medical chart record requests and potential medical chart review. Manage the chart review process by reviewing the record request list, collaborating with information technology (IT) for file accuracy, coordinating the record requests with providers or vendors and collaborating with the chart review vendor, if applicable. Review the medical visit file to determine individuals requiring outreach to coordinate medical services. Assist members in the coordination of appointments for services. Required to complete tracking documentation of medical record requests, chart reviews and medical visit appointments to ensure status is current. Must be analytical and have critical thinking, problem solving and decision making skills. Must be organized and able to multi-task. Must be proficient in computer software such as Word and Excel.

POSITION RESPONSIBILITIES

Applies data analysis and data modeling techniques to establish, modify, and maintain data structure, and its associated components. Assists in assessing risks, benefits and consideration of alternatives. Contributes to standard practices for problem-solving approaches, tools, and processes. Delivers written and oral communication, responds to questions and concerns, and produce specific outcomes and impact. Documents the key steps of a unit-specific risk management process and associated procedures. Explains data analysis results from a business development perspective. Helps promote collaboration across generations, functions, regions, and levels. Organizes key points and supporting information for a topic as appropriate for the audience. Presents a professional image, especially when dealing with customers. Uses a variety of computer hardware, operating systems, utilities and applications.

DEPARTMENT DETAILS

Would prefer someone that is a super-user or willing to be one.

This position will do both Quality in addition to working a few floor shifts per month. This will assist with coverage on the floor, but will also look at processes and quality from working on the floor. Full time; 72-80 hours every 2 week pay period.

QUALIFICATIONS

Currently holds an unencumbered RN license with the State Board of Nursing where the practice of nursing is occurring and/or possess multistate licensure if in a Nurse Licensure Compact (NLC) state. Obtains and subsequently maintains required department specific competencies and certifications. Certified Professional in Healthcare Quality (CPHQ) or medical coding certification preferred, but not required. Quality improvement/assurance personnel with nursing backgrounds can maintain their license without seeking additional hours based on role’s responsibilities. Graduate from a nationally accredited nursing program preferred, including, but not limited to, Commission on Collegiate Nursing Education (CCNE), Accreditation Commission for Education in Nursing (ACEN), and National League for Nursing Commission for Nursing Education Accreditation (NLN CNEA). Bachelor's degree in nursing preferred. Minimum of five years of nursing experience. Experience and knowledge of accreditation and regulatory agency standards preferred. Quality, medical coding, and/or risk adjustment experience is preferred.

About Sanford Health:

At Sanford Health, we are dedicated to the work of health and healing.

Every day, we show that commitment by delivering the highest quality of care to the communities we serve.

We are leaders in health care and strive to provide patients across the region with convenient access to expert medical care, leading-edge technologies and world-class facilities.

In addition to strong clinical care, we are also committed to research, education and community growth.

We engage in medical research to not only discover innovative ways to provide care, but also cures for common diseases.

We continuously seek new ways to achieve our vision of improving the human condition here in your community,

across the region and around the world.

The entire team at Sanford Health recognizes the value of healthy families and communities.

We continue to gain momentum and expand our reach. Together, we can make a positive difference now, and in the future.

Sanford is an EEO/AA Employer M/F/Disability/Vet.

If you are an individual with a disability and would like to request an accommodation for help with your online application,

please call 1-877-673-0854 or send an email to talent@sanfordhealth.org .

In compliance with federal law requiring employers to verify new employees' U.S.

employment eligibility, Sanford participates in E-Verify. To learn more click here for English Version at https://e-verify.uscis.gov/emp/media/resourcesContents/EverifyPosterEnglish.pdf or here for Spanish Version at https://e-verify.uscis.gov/emp/media/resourcesContents/EverifyPosterSpanish.pdf .

City: Canton

State: South Dakota

Job Function: Quality & Risk Management

Job Schedule: Full Time

Shift: Days

Req Number: req24936