Conducting audits of the UAS assessments and related documentation/forms;
Review, monitor and train staff in the Long Term Care Department.
Review care management activities/records of the Care Management Teams and/or activities/clinical documentation submitted by the Intake Specialist.
Confirm accuracy and monitor timeliness in accordance with Fidelis Care’s policies and regulatory standards.
Ensuring adherence to departmental and regulatory data integrity standards and requirements.
Create, analyze, report and maintain metrics and processes in support of department and all relevant NYS programs and product lines.
Summarize findings and report to applicable management, training and retraining staff accordingly.
Spend time in the field while reviewing Intake Specialist work, actively coaching and developing staff with real time training and feedback.
Review clinical documentation to ensure quality standards and accuracy.
Maintain a tracking tool logging unacceptable areas in workflow and staff documentation performance.
Conduct monthly one-to-one sessions with Assessment nurses for re-education on best practices and clinical documentation.
Participate in educational and management meetings for improving clinical core measures.

BA/BS
Bachelors Degree or equivalent experience required.
Knowledge of Department of Health (DOH) and Local Department of Social Services and Center for Medicare & Medicaid Services (CMS) regulations.
Working in a home care environment or as a staff nurse in an acute, sub-acute or long-term care (LTC) setting or managed long-term care plan (MLTCP);
Proficiency with healthcare terminology such as ICD 10 codes, medical abbreviations, medications.
Experience in medical records review, claims processing or utilization and case management in a clinical practice or managed care organization.
Experience analyzing various types of data and processes in a versatile manner including ability to present findings and make recommendations.
Microsoft Excel skills with the ability to edit, search, sort/filter, format/use styles, create tables, calculate data using functions and formulas and create/use PivotTables for analyzing data.
Active NY RN License.
Bilingual language preferences: Spanish, Russian, French, Creole, Mandarin, Shanghainese, Suzho, Cantonese, Toishanese, Fujianese, Fukanese, Fuzhounese Hindi, Bengali, Urdu or Nepali.

Quality Assurance RN – LTC

About this role