Nurse - Quality Review Auditor (16020)

Job Description

Key Qualifications:
Licenses & Certifications:
NY License, RN

Minimum Education:
Associates

Languages:
English

Years of Experience:
2+ years

Schedule Details:
On Call, 5 days/week

Care Settings:
Skilled Nursing Facility

Benefits:
Sign on bonus, Education Reimbursement, Full benefits

About this Company:
Our range of health services include home care, hospice and palliative care for adults and children, rehabilitation and nursing care, and our research-based Institute for Innovation in Palliative Care. We also offer health plans for Medicare and dual-eligible individuals.

Compassion is a fundamental element of our care and core values. For our staff, working here is not just a job. It’s a calling. We go above and beyond routine protocols. We become involved and invested in our patients’ lives. We take the time to understand them as people, not just as patients. We know that each act of loving-kindness, consideration and accommodation, however small, makes a big difference.


Overview:
Job Description
As the Quality Review Auditor (QRA) you will be responsible for ongoing audits of the care management staff, quality assurance, accuracy and overall integrity of the care management records and documentation.

You will be responsible to analyze collected audit data, identify trends for staff re-training and implementing corrective action plans in collaboration with Coordinated Care Management staff.

***Candidates should have worked as an RN Care Manager for another MLTC (Managed Long Term Care) or Medicare plan and there are many federal and state regulations that they need to be aware of (this would be a nice step up for someone who wants to advance out of a Care Manager role)

Required skills & experience (the “must haves” to be considered)
1. Graduate from an accredited School of Nursing. BSN or BS degree preferred
2. Minimum of two (2) years experience in care management required***
3. Licensed to practice as Registered Professional Nurse in NYS
4. Knowledge of Medicare and Medicaid regulations
5. Working knowledge of State and Federal regulations
6. Travels to perform business partners training