Nurse Auditor


ABOUT THE POSITION

The Nurse Auditor is an experienced healthcare professional with relevant experience in the field of risk management and quality improvement.  This position plays a key role in the proper identification quality-based and risk-based adjustments/conditions within the clinical documentation.  This position assists with the morbidity and mortality functions within CHC/SEK’s Compliance Department.

ESSENTIAL DUTIES

  1. Reviews and interprets patient records and care plans against criteria to determine appropriate documentation based on clinical practice guidelines and appropriateness of care; determines if the patient file documentation supports the patients’ need for services.
  2. Identifies documentation issues (e.g. lacking documentation) that impact risk management, quality improvement, and revenue cycle.
  3. Identifies opportunities to implement best practice approaches and innovations to improve outcomes and enhance organizational efficiency.
  4. Clearly communicates (verbally and in written reports or summaries) opportunities for documentation improvement related to risk adjustment coding and clinical documentation issues.
  5. Orients and educates staff to documentation standards, legal requirements, and the performance improvement process as necessary; reports aberrant and non-compliant occurrences.
  6. Assists with internal audits and surveys to ensure adherence to CHC/SEK policies, state and federal guidelines, and appropriateness of patient care.
  7. Completes assigned audit deliverables and surveys in a timely, efficient and accurate manner, meeting all identified deadlines.
  8. Able to translate EHR data into meaningful data outcomes.
  9. Assist with research, analysis, and review activities related to CHC/SEK’s Morbidity and Mortality functionalities.
  10. Reviews all CHC/SEK patient death certificates and does associated research, documentation, and follow-up, as directed by CHC/SEK’s Compliance Officer and/or Risk Manager.
  11. Supports other Risk Management and Quality Improvement efforts (e.g. peer review processes).
  12. Perform all duties, services and documentation in full compliance with CHC/SEK policies and procedures.
  13. Performs other duties as assigned.

QUALIFICATIONS

  1. Registered Nurse with Three (3) or more years of experience required.
  2. Strong knowledge of quality improvement training (e.g. NCQA) preferred.
  3. Strong knowledge of risk management training and coding (e.g. HEDIS, ICD) preferred.