Clinical Quality Compliance Consultant

Advocate Health and Hospitals Corporation • High Point, NC

1d • $38 - $56 • Onsite

About The Position

Facilitates compliance with evolving quality measures including, TJC Oryx Reporting of Core Measures, Leapfrog, CMSs National Hospital Quality Measures, and National Quality Forum quality measurement and reporting requirements, and other benchmarking reporting requirements. Develops both measurement and improvement strategies for assigned performance measures and programs. Oversees clinical review in area of responsibility to ensure complete and accurate data collection and data entry for assigned performance measures and programs/projects within established timeframes. Works with Quality Department leadership to investigate quality concerns or issues arising from external payer reviews, external clinical benchmarking efforts (NSQIP, UHC, Leapfrog, TJC, etc.), or tracking of surveillance of major outcome measures (e.g., mortality, readmission, and reoperation rates). Provides concise clinical quality review findings, develop recommendations for corrective actions and/or improvement opportunities to leadership as warranted, and track the impact of implemented changes. Works with assigned team and quality leaders across the medical center to strengthen clinical documentation and coding to ensure that all DRG related and CPT related coding accurately reflects the patient's complexity and clinical course. Monitors review process for all hospital acquired conditions and publicly reported conditions to ensure accuracy of information provided to regulatory reporting agencies. Works with Quality Assessment Director and Performance Excellence division leaders to manage specified quality and safety related projects as determined by leadership, including developing project timelines, agendas, reports, and presentations to various audiences as appropriate. Establishes effective and collaborative working relationships with members of the hospital community, clinical departments, administrative departments, and quality and safety staff across Wake Forest Baptist Health. Keeps current with data abstraction specifications, emerging trends in hospital quality and reporting initiatives, and integrates key concepts into work. Performs other duties as assigned.

Requirements

• Graduation from an accredited School of Nursing with a Bachelor's degree in Healthcare of a Business related field; or, ten years nursing experience in an academic medical center and three years of clinical quality review related work experience required
• Current license to practice as a Registered Nurse (RN) in the State of applicable state.

Responsibilities

• Facilitates compliance with evolving quality measures including, TJC Oryx Reporting of Core Measures, Leapfrog, CMSs National Hospital Quality Measures, and National Quality Forum quality measurement and reporting requirements, and other benchmarking reporting requirements.
• Develops both measurement and improvement strategies for assigned performance measures and programs.
• Oversees clinical review in area of responsibility to ensure complete and accurate data collection and data entry for assigned performance measures and programs/projects within established timeframes.
• Works with Quality Department leadership to investigate quality concerns or issues arising from external payer reviews, external clinical benchmarking efforts (NSQIP, UHC, Leapfrog, TJC, etc.), or tracking of surveillance of major outcome measures (e.g., mortality, readmission, and reoperation rates).
• Provides concise clinical quality review findings, develop recommendations for corrective actions and/or improvement opportunities to leadership as warranted, and track the impact of implemented changes.
• Works with assigned team and quality leaders across the medical center to strengthen clinical documentation and coding to ensure that all DRG related and CPT related coding accurately reflects the patient's complexity and clinical course.
• Monitors review process for all hospital acquired conditions and publicly reported conditions to ensure accuracy of information provided to regulatory reporting agencies.
• Works with Quality Assessment Director and Performance Excellence division leaders to manage specified quality and safety related projects as determined by leadership, including developing project timelines, agendas, reports, and presentations to various audiences as appropriate.
• Establishes effective and collaborative working relationships with members of the hospital community, clinical departments, administrative departments, and quality and safety staff across Wake Forest Baptist Health.
• Keeps current with data abstraction specifications, emerging trends in hospital quality and reporting initiatives, and integrates key concepts into work.
• Performs other duties as assigned.

Benefits

• Day 1 Health Coverage: Choose from either copay or HSA-eligible health insurance options with coverage starting on your first day of work.
• Generous PTO: Accrual starts at up to 25 days/year, to be used for vacations, sickness, holidays, and personal matters.
• Parental Benefits: Six weeks paid birthing-mother maternity leave & four weeks paid parental leave for non-birthing parents.
• Retirement: Up to 7% employer-paid retirement contributions
• Education Reimbursement: We invest in your professional growth, offering up to $2,500 per year towards a bachelor's degree and up to $5,000 per year towards a graduate degree.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level