Landmark Health Quality Nurse Auditor in Kansas City, Kansas

The Quality Nurse Auditor (QNA) is responsible, as part of the Landmark Health team, for completing chart audits associated with CCM (Complex Case Management), quality assurance related to CCM Delegation, and supporting team members with training related to CCM processes. The Quality Nurse Auditor completes independent assessments of patient charts in accordance with policies and procedures, clinical guidelines, applicable regulatory standards and client requirements. The Quality Nurse Auditor will support general quality management initiatives, including but not limited to working closely with the Health Services Director, Regional Medical Director and the VP/ General Manager to insure the company meets the standards for NCQA delegation, and then subsequently works to insure the Market continues to operate at such standards. The QNA will assist with training new employees on the NCQA standards, chart audit processes, care planning requirements in addition to supporting current team members with continuing education and training.

The QNA uses assessment and evaluation skills to audit CCM chart documentation and care plan processes. Working collaboratively with the multidisciplinary team and Market leadership, the QNA provides audit results, makes recommendations to improve quality and implement training strategies to improve audit results. If market needs arise, the QNA will also have a small panel of members to manage in Landmark’s Longitudinal Care Management program. Strong CM knowledge and experience is necessary.

  • Conduct Complex Care Management chart audits

  • Review of daily huddle sheet to identify those patients referred to CCM

  • Track all CCM referrals including key indicators vs. timeline (i.e. HFA, HSA and care plans quality)

  • Conduct CCM delegation training for new hires and ongoing training based on audit results and team member needs.

  • Independently use discretion and judgment to evaluate objective and subjective clinical documentation to assess performance of nursing skill and the skills of other allied health professionals, based on Business Unit expectations for performance

  • Applies advanced knowledge to conduct multi-specialty subjective assessments to evaluate the skills of nurses and other allied health professionals

  • Consults with the Regional Medical Directors, Health Services Director to collaborate on subjective assessments to ensure consistency of feedback related to complex, high risk cases

  • Responsible to ensure evaluation tool components for subjective skills assessments comply with quality standards and follow policies, State regulations and Accreditation standards

  • Collate all data available to illustrate a full picture of an individual staff members performance

  • Generate reports /findings of reviews: in a clear, concise manner that is understandable and actionable

  • Provide consultation to support staff coaching and development efforts

  • Assist, as needed, to determine areas that require immediate remediation and assist employees to stay ahead of changing information while improving the quality and effectiveness of clinicians and member engagement

  • Identifies tracks and records best practices, sharing the specifics with team leadership

  • Participate in and conduct training and performance improvement related projects to support staff development as well as assist with the training of new employees

  • The Clinical Nurse Auditor will highlight key findings for implementation of performance improvement plans when necessary

  • Participate in NCQA accreditation activities

  • Work with colleagues across Market units to ensure that process and procedural changes are reflected in staff member documentation such as job aids and policies

  • Assist with gathering data for routine reporting with other team members to be used for day-to-day purposes and at meetings

  • Maintain a tracking tool that will log areas in the workflow and staff documentation performance indicating improvement is needed for discussion with management and/or at departmental team meetings

  • Responds to and evaluates self-performance and adjusts performance related to feedback from manager and teams served

  • Ability to communicate in person, by phone, or via e-mail in a professional and friendly manner

  • Ability to work and interact with professionals as part of an interdisciplinary team

  • Self-motivated, flexible person who can flourish in an office setting with colleagues as well as in a self-structured independent setting

  • Ability to accept constructive feedback for continual improvement

  • Ability to add to a team atmosphere where a team approach is highlighted and valued

  • Thrives in a process based transactional work environment

  • Able to work independently; self-motivated with good organizational skills

  • Quickly adapt to new technology

  • Must stay abreast of all customer specific details, to ensure high quality customer service

  • Accept additional assignments willingly

  • Basic computer knowledge such as Word and Excel.

  • Strong administrative, clerical and organizational skills.

  • Excellent customer service and follow-up skills

  • Strong attention to detail

  • RN with earned BSN required

  • 2 or more years of clinical audit experience preferred

  • RN required in the state that you reside (must have active, unencumbered RN license in Kansas and willingness to obtain RN licensure in Missouri, LA and Mississippi)

  • IRR (inter-rater reliability) experience preferred

  • Knowledge of CCM (certified CCM preferred)

  • NCQA knowledge and experience preferred

  • Quality Assurance/Auditing experience preferred

  • Experience in case management, assessments and care planning required

  • CCM/Delegation auditor experience preferred

  • HEDIS familiarity preferred

  • Certified Auditor (Landmark will do the education and certification)

WORK ENVIRONMENT

Below is a description of the work environment that the employee will encounter while performing the essential functions of the job.

  • Initial high frequency visits to patient residences followed by as needed visits

  • Will require occasional travel to the LA/ Mississippi Market

  • Noise level is usually moderate

Job ID: 2018-2203

External Company URL: landmarkhealth.org