Purpose of Position:
Support the Director of Quality Improvement to develop, manage, and measure a comprehensive healthcare strategy to promote health, wellness, and disease prevention utilizing available resources to analyze healthcare data to determine areas for improvement.
Provide support to NSHC as well as local, State, and National agencies in collection of health care data necessary for disease tracking, quality analysis and resource utilization.
Utilize risk management software and strategies to evaluate local and statewide trends and make suggestions for improvement.
Perform nursing utilization review activities in accordance with State, Federal, and private accrediting and licensing agencies, medical staff and NSHC vision, mission and corporate values.
Uphold the organization’s vision, mission, and corporate values. Demonstrate understanding of and compliance with organization’s policies, procedures, code of conduct and work rules.
Essential Functions:
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Monitor data related to Acute Care Hospitalizations
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Monitor outcomes data on Hospital Compare and Quality Net
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Investigate negative trends and suggests tactics to reverse
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Import and save reports from outside website
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Prepare and submit necessary clinical data for external reports to include Cancer registry, Partnership for Patients and others as directed by the Director of Quality Improvement and Risk Management.
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Utilize Risk Management tracking software to evaluate trends and suggest areas of improvement.
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Assist as needed with compliance and survey preparation
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Assist as needed with on-site record reviews
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Maintain confidentiality of patient and corporate information
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Provide educational programs and orientation of utilization review objectives
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Conduct admission and continued stay reviews on applicable patients and notify insurers of inpatient admissions, offer applicable information and obtain PAR/Authoriation and work closely with physicians to identify and resolve concerns
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Conduct audits for compliance with billing requirements and compile data for various registries, reports and reviews
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Track, prepare and send appeals for payment denials
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Perform other duties as assigned
Personal Traits:
All Norton Sound Health Corporation employees are expected to consistently demonstrate the organization’s values: integrity, cultural sensitivity and respect for traditional values, continual learning and improving, compassion, teamwork and pride. Employees are expected to demonstrate integrity, professionalism, accountability, cooperation with and consideration of others.
Required Knowledge:
All Norton Sound Health Corporation employees are expected to have general knowledge of typical office technologies such as computers, printers, copiers, fax machines, and typical office software.
Job-Specific knowledge:
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Working knowledge of Medicare and Medicaid regulations for Critical Access Hospitals
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Working knowledge of Joint Commission Standards of Nursing Care for Critical Access Hospitals
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Ability to communicate effectively with medical staff and multiple departments to facilitate patient care and process development and implementation.
Required Skills and Abilities:
All Norton Sound Health Corporation employees are expected to have a broad range of skills and abilities centered around a strong patient focus, efficient performance, and teamwork. All employees should have patient/customer service skills, interpersonal skills and good communication skills. All employees should have the ability to manage their time and organize their work to ensure efficient performance. In addition, all employees should have the ability to follow policy, procedure and instructions, actively communicate with their supervisors to ensure understanding and manage their work accordingly. Finally, all employees should have the ability to understand and manage patient/customer confidentiality.
Job-specific skills and abilities:
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Excellent interpersonal skils
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Above-average communication and customer service skills
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Ability to formulate reports utilizing multiple computer programs/software
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Above-average typing and computer skills with Excel and Word
Minimum Requirements
Experience
General (Non-supervisory)
Supervisory
Amount:
3 - 5 year(s)
nursing experience
2 year(s)
Must have both general and supervisory experience if indicated.
Credentials
Licensure, Certification, Etc.
Physical Requirements:
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Use hands and arms to operate office or clinical equipment
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Sit more than half the workday
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Stand and/or walk less than half the workday
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Bend, stretch, twist, crouch and/or reach
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View electronic monitors for prolonged periods of time
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Use hands and arms for repetitive motion tasks
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Lift or carry unaided up to 25 pounds
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Push or pull using up to moderate force
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See and hear with normal acuity
Working Conditions:
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Work is conducted in a standard office environment as well as a standard clinical environment, including exposure to latex, biohazard or other harmful substances
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Moderate travel is required (between 25% and 50% of the time)
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Travel is required via large aircraft
