Clinical QA Auditor (Healthcare)
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At PACS, we believe our employees are our greatest asset. That's why we offer an exceptional benefits package designed to enhance your well-being and support your lifestyle.
Our Comprehensive Benefits Include
- Health Coverage: Enjoy medical, dental, and vision plans to keep you and your family healthy.
- PTO and Vacation: Benefit from generous paid time off and holidays to relax and recharge.
- Financial Wellness: Take advantage of Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA) to manage your healthcare expenses effectively.
- Retirement Planning: Secure your future with our 401(k) plan, complete with company contributions to help you build your retirement savings.
- Support When You Need It: Our Employee Assistance Plan (EAP) provides confidential support for personal and professional challenges.
Join us at PACS and take advantage of a workplace that truly values you!
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PACS is elevating healthcare by revolutionizing our approach to leadership and quality care. Guided by our core values of love, excellence, trust, accountability, mutual respect, and fun, we strive to foster a culture of compassionate care within our teams and the communities we serve. As we grow rapidly, exciting opportunities await you to engage in impactful projects and contribute valuable insights to stakeholders nationwide.
If you're ready to make a difference and embrace our mission of creating real change, we invite you to join us at PACS. Together, let's shape the future of healthcare!
General Purpose
Clinical QA Auditor - PACS: responsible for the regulatory oversight of multiple facility clinical programs located in different states. This position provides support and education for nursing clinical programs. The primary purpose is to assist with the design and implementation of clinical audits in vital areas requiring clinical improvement and then providing support and education that ensures regulatory compliance. The position requires collaboration between Compliance Team members and Regional Teams (RDCS, ARDCS, RAI
Specialists, IP Nurses). This includes but is not limited to training of nurses in proper daily skilled documentation, wound documentation, and risk reduction. Recommendations will strictly adhere to Medicare guidelines and PACS Best Practices.
Essential Duties
- Supports State and Federal Regulatory Compliance with monitoring, education, and implementation of
- clinical programs while collaborating with other members of the PACS Compliance Team and local PACS Regional Team members.
- Provides Facility Trainings as needed to support local facility clinical operations
- Educates and Mentors Registered and Licensed Nursing staff as necessary for proper daily skilled
- documentation and special focus areas including PDPM active diagnosis, fall management, wound treatment, and care planning in the EMR.
- Reviews EMR and Point Right to ensure strict compliance with Medicare guidelines
- Collaborates with Legal Team to monitor high risk liability areas and assist facilities to alleviate liability risk
- Tracks and trends clinical metrics for identified risk areas
- Participates in Facility CSR, Triple Check, and other meetings as directed
- Supports administrators in achieving clinical outcomes which adhere to industry standards of care and regulatory requirements.
- Intensive auditing responsibility of pertinent clinical topics.
- Monitors for trends affecting workflow, facility liability, and risk management
- Interface with other regional personnel to promote standardization across region
- Identifies opportunities within facilities for new programs (i.e. Certified wound treatment)
- Supports facility with clinical reviews for probes, CERTs, ADR's, and ALJ's
- Reports to Vice President of Compliance Support any concerns with compliance or lack of adherence to company best practices
- Assists with Wound Module Training in the EMR
- Provides recommendations to supervisor for opportunities to improve company
- Must be able to travel by car and/or plane when necessary to reach assigned destination in a reasonable time frame
- Must maintain confidentiality of company and patient information
- Promotes positive attitude to coworkers and to company regarding the company, its mission statement, philosophies, and goals
- Inspire others to elevate their level of commitment
- Complete ongoing education with follow up in-service to appropriate audience on new material
Qualifications/Experience
- LVN/LPN or RN with associate or bachelor's degree in nursing with DON or equivalent SNF experience 5yrs.
- Proficient in computer skills and utilizing data in programs such as QIES Casper, Point Right, and Point Click Care.
- Prefer RAC-CT Credential
Language Skills
Ability to read technical procedures. Ability to read and comprehend policy and procedure manuals. Ability to effectively present information and respond to questions from managers, PACS coworkers, and facility employees.
Mathematical Skills
Ability to apply concepts such as fractions, percentages, ratios and proportions to practical situations.
Reasoning Ability
Ability to solve practical problems utilizing critical thinking. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
Certificates, Licenses, Registrations
Expertise in Excel, Word, and document development
Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully
perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with
disabilities to perform the essential functions. The employee must occasionally lift and/or move up to 25 pounds.
Prolonged use of a desktop or laptop computer. While performing the duties of this job, the employee is regularly
required to sit, stand, walk, talk, read, hear, and listen attentively. Frequent use of all office related equipment to
include: copier/scanner/fax, telephone, calculator. Travel by auto or airline may be required.
Work Environment
The work environment characteristics described here are representative of those an employee encounters while
performing the essential functions of this job. Reasonable accommodations may be made to enable individuals
with disabilities to perform the essential functions.
The noise level in the work environment is usually low to moderate.
Additional Information
Note: Nothing in this job specification restricts management's right to assign or reassign duties and
responsibilities to this job at any time. Critical features of this job are described under various headings above.
They may be subject to change at any time due to reasonable accommodation or other reasons. The above
statements are strictly intended to describe the general nature and level of the work being performed. They are
not intended to be construed as a complete list of all responsibilities, duties, and skills required of employees in
this position.
