Quality Assurance and Clinical Documentation Nurse
Job ID: R0029478 | Advance Practice Provider | Full Time | Charlottesville, VA
The Quality Assurance and Clinical Documentation Nurse will integrate clinical experience with the technical functions of data collection, quality measurement and improvement, and reporting. This position will be responsible for turning data acquired from a variety of sources (e.g., the electronic health record, billing claims, cost reports, and patient satisfaction surveys) into relevant, accurate and timely information for providers, payors, regulators, department leadership and administration. Reporting to the Director of Managed Care Contracting, this position requires a high level of clinical judgment, analytical and technical skills, creativity, organization, and priority setting.

The Quality Assurance and Clinical Documentation Nurse will collaborate across the organization on all aspects of clinical data management, including ownership of validation and integration of data into clinical repositories, quantitative analysis and presentation of findings, leadership of efficient processes to accurately capture quality performance and maximize incentive-based reimbursement, and act as a clinical and technical resource to consider data capture needs in EHR workflow builds. This role will also participate in and lead projects to improve the capture, use and efficiency of clinical documentation.

Responsibilities include:

  • Uses advanced knowledge of software systems, databases and statistical process to coordinate, maintain and provide meaningful information to physician leadership, management and teams to evaluate clinical practice, process and High Value outcomes.

  • Performs retrospective chart reviews, completes clinical data abstraction, and uses CDI best practices to ensure accurate charting, reimbursements and appropriate patient care.

  • Presentation experience and/or skills to present meaningful information/data to a diverse group of roles.

  • Collects data, conducts analysis, synthesizes findings, and communicates results for various quality measures.

  • Prepares regular dashboard reports as requested and communicates measures results, variances and opportunities for improvement.

  • Provide accurate reporting to national agencies and local healthcare organizations.

  • Researches patient data across multiple applications to resolve discrepancies and/or improve work flows in payor incentive program data, including attribution, risk scoring and care gaps.

  • Performs ongoing data verification and validation to ensure timeliness, validity, accuracy, integrity and inter-rater reliability of all data elements.

  • Assists with analysis of external data definitions documentation and mapping process.

  • Serves as a resource for others and has knowledge of the measure sets, sampling requirements, data definitions and reporting specifications.

  • Participates in quality improvement activities that will promote high value care and address opportunities identified in the abstraction, analysis or synthesis process.

  • Validates data load processes and the quality of the data loaded into clinical data repositories.

  • Responsible for maintaining, storing, mapping and analyzing health data in compliance with HIPAA policies and procedures.

  • Development of clinical data testing systems, including design, documentation, implementation and reporting.

  • Collaborates with clinical staff and development teams to design and develop clinical documentation based on workflow processes, regulatory standards and technological solutions.

  • Recommends innovative ideas, processes, and/or procedures for enhancements, additions, and modifications to improve existing systems.

  • Familiarity with internal and external sources of demographic, financial, and utilization data.

  • Other duties, as assigned.


MINIMUM REQUIREMENTS

Education:
Master's Degree in Nursing, Informatics, Data Analytics or related field required.
Experience:

  • 5+ years' experience in healthcare quality data analytics, HEDIS, Managed Care Quality, Utilization Review or Case Management.
  • Two or more years of clinical nursing practice. EMR experience required.

Preferred Experience:

  • Active Registered Nursing license in the Commonwealth of Virginia

  • Considerable experience with EPIC strongly preferred

  • Certified Professional in Healthcare Quality

  • Strong understanding of requirements and reporting for Pay for Performance, Patient Centered Medical Home and other regulatory agency criteria for performance improvement and clinical resource analysis.

  • Database data entry and/or management experience.

  • Quality improvement or patient safety knowledge and experience.

  • Ideal candidates will have experience building their own queries in SQL and ACCESS or Tableau, as well as experience in data modeling, healthcare (other insurance), or financial industries.


Licensure:

  • License or license eligible as an Advance Practice Provider (Nurse Practitioner, Physician Associate, Certified Registered Nurse Anesthetist, and Certified Nurse Midwife) as set forth by the state of Virginia. If Nurse Practitioner, license to Practice as a Registered Nurse in the Commonwealth of Virginia is required.
  • Must demonstrate and maintain all credentialing and licensing requirements of UVA Health System, the Virginia Board of Medicine or the Virginia Board of Nursing, and appropriate certifying bodies.


PHYSICAL DEMANDS

Job requires standing for prolonged periods, frequently bending/stooping, reaching (overhead, extensive, and repetitive); Repetitive motion: computer keyboard. Proficient communicative, auditory and visual skills; Attention to detail and ability to write legibly; Ability to lift/push/pull 50 - 100lbs. May be exposed to noise, radiation, radioactive materials, blood/body fluids and infectious disease.


COVID Vaccination Requirement

Due to the scope of President Biden's Executive Order 14042 issued in early September, all University employees, including remote employees, must receive their final vaccination dose by January 4, 2022, unless they have a University-approved religious or medical exemption. The University has updated policy SEC-045 to reflect these new requirements.

If hired by the Academic Division, excluding School of Medicine, School of Nursing, UVA Physicians Group, and the Health Systems Library, you will be required to provide proof of vaccination or be willing to be vaccinated by January 4, 2022. Academic employees may apply for a University-approved medical or religious exemption.

Note: Some medical and safety-sensitive positions require vaccination and are not eligible for an exemption. For more information on how vaccination requirements will apply to you, please visit the UVA New Hire Vaccination Requirements webpage.

 


Charlottesville, VA
Charlottesville, VA 22903
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Working here.

Since 1979, UPG has been the clinical partnership group managing, growing and providing direct patient care for all UVA entities. This strategic partnership allows UVA to expand on education, technology, diagnostics, resources and facilities while the teams at UPG can focus on managing and delivering high-quality, multi-specialty care.

The expansive network of UPG providers and clinical support teams work together to deliver world-renowned care to patients at UVA Medical Center in Charlottesville and in 24 primary and specialty care clinics located throughout central and northern Virginia.

Quality of Life

Charlottesville, Virginia is one of the nation’s most charming and picturesque places to live and work. Our area boasts many excellent restaurants, wineries and craft breweries; historic sites; Shenandoah National Park and Skyline Drive; and a great selection of homes in welcoming neighborhoods, as well as urban and rural locations. Public transportation is excellent, and you’re just a short drive from the beach or Washington, D.C.