Clinical Audit Manager- Long Term CarePosted: November 13, 2009
POSITION SUMMARY: Under the direction of the Vice President of Internal Audit and Compliance, the Manager is primarily responsible for implementation of clinical audit reviews as assigned. The Manager will perform audit procedures that focus on residents’ quality of care, the adequacy of medical records, and the accuracy of Medicare/Medicaid Minimum Data Sets (MDS) in accordance with Clinical Audit review processes. The reviews will evaluate performance related to standards of professional nursing practices, Company policies and procedures, and Federal and State rules and regulations. The individual must have experience in the long term care nursing environment. A comprehensive knowledge of the Medicare Prospective Payment System (PPS), along with Medicaid and OBRA MDS assessment requirements is essential. Above-average oral and written communication skills are necessary. Proficiency with Microsoft Word and Excel is highly desirable. The Manager will collaborate with the other members of the department in the development of new audit procedures as necessary. This position requires 10% travel, with potential for some overnight required. RESPONSIBILITIES/ACCOUNTABILITIES: 1. Performs reviews per GHC Clinical Audit procedures. These reviews will focus on resident quality of care, resident and employee safety, and medical record documentation to ensure compliance with Federal, State and third party payer regulations, and Center compliance with Company policy and procedure. 2. Discusses audit findings with the Vice President of Internal Audit and Compliance throughout all phases of the review process. 3. Compiles audit reports according to Internal Audit protocols. Presents reports to the Vice President of Internal Audit and Compliance for review prior to release. Conducts correspondence with Centers and Area Management for clarification and follow-up as may be required. Distributes reports in a timely manner to Centers and responsible GHC Management for appropriate corrective action. Performs follow up work pertinent to implementation of corrective action plans. Reports follow up findings to resolve reviews. 4. Works with GHC employees and affiliates to facilitate the compliance of proper resident medical record documentation and coding accuracy of services on the Minimum Data Set (MDS). 5. Assists in the development and revision of clinical audit reviews as needed. 6. Participates in special projects and other duties as assigned by the Vice President of Internal Audit and Compliance and/or the GHC Legal Department. SPECIFIC EDUCATIONAL/VOCATIONAL REQUIREMENTS: 1. Graduate of an approved school of nursing with current licensure as a Registered Nurse 2. A BS or BA degree is desirable; exemplary clinical reimbursement skills will be considered in lieu of a bachelor’s degree. 3. A minimum of five years experience in the long term nursing environment that includes a supervisory position, and/or a Clinical Reimbursement Coordinator or RNAC position 30781
Please refer to job code 30781 when responding to this ad.
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