Quality Specialist- CDI/Denials

Alomere Health • Alexandria, MN

1d

About The Position

The Quality Nurse shall be under the general supervision of the Supervisor of Quality. This position performs essential duties related to Quality and specialty programs such as Clinical Documentation (CDI) and Utilization Review (UR). The Quality Nurse will assist with education, data abstraction, ACHC Standard review, Quality of Care reviews, Payer appeals, complaints and other duties as assigned.

Requirements

• Graduate of an accredited RN Program
• Minimum of two years’ experience in an acute care hospital and patient care practice
• Active and current RN registration/licensure in the state of Minnesota

Nice To Haves

• Experience or training in Quality, or Quality-related training

Responsibilities

• Interact closely with Physicians for Clinical Documentation Integrity and Utilization Review
• Complete full CDI training with ability to share lead CDI Nurse duties
• Learn elements of the UR Program with ability to review and assist as needed
• Ability to work independently as well as with other members of the Quality Team
• Comply with confidentiality of the medical records
• Collaborate with the Quality Supervisor, Director of Quality & Risk Management, Physicians and other members of the healthcare team
• Ability to speak directly to physicians, providers and staff on quality-related projects or concerns
• Assist in quality (Abstracting), Clinical Documentation Improvement (CDI) and case reviews for overall quality improvement
• Assist with patient concerns under the direction of the Department Director
• Perform all other related duties as assigned in a professional and responsive manner
• Demonstrate the ability to use relevant equipment
• Support, understand, and promote Alomere Health’s mission, vision, values, policies and procedures
• Ability to meet the work schedule requirements with flexibility depending upon the needs of the department
• Foster respectful working relationships with professional colleagues, patients, families, and general public regardless of age, gender, lifestyle, culture, beliefs, race, socioeconomic class, or ability

Benefits

• Health, Dental, and Vision Insurance
• Employee Health Clinic (health +): Our health+ clinic provides office visits and prescription medications for little to no cost to Alomere Health employees and their dependents who are on a medical insurance plan
• Retirement Savings: (401(k)) - All eligible employees of Alomere Health are automatically enrolled. All eligible employees are able to contribute on a pre-tax and/or post-tax basis and Alomere Health matches 100% up to 6% of employee's contributions.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed