Quality Assurance RN – LTC

Job Description

This role involves conducting audits of UAS assessments and related documentation/forms. You will review, monitor, and train staff within the Long Term Care Department. The role includes reviewing care management activities and records of Care Management Teams, along with clinical documentation from Intake Specialists. Accuracy and timeliness must be confirmed and monitored according to Fidelis Care’s policies and regulatory standards. Adherence to departmental and regulatory data integrity standards and requirements must be ensured. You will also create, analyze, report, and maintain metrics and processes to support the department and relevant NYS programs and product lines. Summarizing findings and reporting to management, along with training and retraining staff, is crucial. Spending time in the field, coaching and developing staff with real-time feedback, is also required. Additionally, you'll review clinical documentation to ensure quality and accuracy, maintain a tracking tool for unacceptable workflow areas, and conduct monthly sessions with Assessment nurses for re-education on best practices. Participation in educational and management meetings for improving clinical core measures is expected.

Qualifications

1. A Bachelor's Degree or equivalent experience is required. 2. Must have knowledge of Department of Health (DOH) and Local Department of Social Services and Center for Medicare & Medicaid Services (CMS) regulations. 3. Experience in a home care environment or as a staff nurse in an acute, sub-acute, or long-term care (LTC) setting or managed long-term care plan (MLTCP). 4. Proficiency with healthcare terminology such as ICD 10 codes, medical abbreviations, medications. 5. Experience in medical records review, claims processing, or utilization and case management in a clinical practice or managed care organization. 6. Proven experience analyzing various types of data and processes with the ability to present findings and make recommendations. 7. Proficient in Microsoft Excel, including editing, searching, sorting, formatting, creating tables, and using functions, formulas, and PivotTables for data analysis. 8. Must possess an active NY RN License. 9. Bilingual language preferences include Spanish, Russian, French, Creole, Mandarin, and other dialects of Chinese, Hindi, Bengali, Urdu, or Nepali.

Benefits

- Competitive pay - Health insurance - 401K and stock purchase plans - Tuition reimbursement - Paid time off plus holidays - Flexible approach to work with remote, hybrid, field, or office work schedules