Nurse Auditor

St. Paul's Senior Services•San Diego, CA

7d•Onsite

About The Position

San Diego’s St. Paul's PACE program (Program of All-Inclusive Care for the Elderly). This innovative program is for individuals 55 years or older, who are living with chronic illness, or disabilities and need coordinated medical care to continue living as independently as possible in their home and community. The healthcare teams at St. Paul’s PACE provide a hands-on approach coordinating medical, social, and home care services so individuals no longer need to manage their medical care alone. Job Summary: The Nurse Auditor is responsible for conducting ongoing audits, monitoring, and data analysis to comply with local, state, and federal regulations and adherence to established nursing standards and best practices. This role involves the development, implementation, and evaluation of quality improvement and compliance initiatives aimed at enhancing patient outcomes and ensuring the highest levels of safety and care. The Nurse Auditor will effectively collaborate with the interdisciplinary teams and non-clinical staff to maintain high standards of care and support for the elderly.

Requirements

Requires an active and unrestricted CA RN license
Must be a graduate of an accredited school of nursing
BSN preferred, but ADN will be considered
Minimum of one year’s experience working with the frail or elderly .
Minimum of three years of hands-on clinical experience or experience in case management preferred. One to three years of relevant quality, compliance, and/or auditing experience in PACE or aging services compliance highly desirable.
Attention to detail and excellent analytical skills
Excellent written and verbal communication skills and interpersonal abilities
Ability to work independently and as a part of a team and prioritize tasks
Proficiency in using electronic medical records and other healthcare software
Understanding of quality improvement concepts and LEAN methodology
Strong knowledge with DHCS, CMS, and/or NCQA requirements and an understanding of clinical audit and documentation standards
Ability to facilitate effective meetings.
YOU MUST BE ABLE TO CLEAR FINGERPRINTS THROUGH DOJ AND FBI IN ADDITION TO A DRUG SCREEN CLEARANCE.

Nice To Haves

Certifications such as Certified Professional in Healthcare Quality (CPHQ) or Certified Inpatient Coder (CIC) can be advantageous.

Responsibilities

Using clinical experience and expertise, conduct routine and complex compliance audit activities (e.g., reviewing of medical records, conducting walkthroughs), documenting and analyzing results, and proposing recommendations for improvement of internal departments and external partners.
Audit patient records for completeness, consistency, and appropriateness of care.
Identify discrepancies and provide feedback to clinical and non-clinical staff for correction.
Analyze trends and patterns in documentation to identify areas for improvement.
Collaborate with nursing leaders to develop and implement strategies for enhancing quality of care.
Participate in quality improvement and compliance initiatives and committees.
Develop audit materials and processes to maintain appropriate auditing practices based on CMS and DHCS requirements
Write accurate and high-quality audit reports using clinical knowledge to determine findings.
Proactively identify support opportunities surrounding health and safety, clinical compliance, and quality improvement
Comply with HIPAA, Privacy, and Confidentiality laws and regulations
Other duties as assigned