Nurse Compliance Auditor

Position Purpose:

Under the direct supervision of the Director of Quality Assurance, the Licensed Nurse is responsible for supporting the compliance functions of the Quality Assurance and Performance Improvement department of JWCH. The responsibilities include:

Maintaining defined review schedule for JWCH agency by (1) doing preparatory work for the audit including developing a scope of work, (2) reviewing the documentation, (3) preparing reports, (4) doing any necessary follow-up reviews and (5) ensuring that appropriate collected data are securely kept and maintained.

Serve as a resource to clients in answering compliance questions from Internal Audit and Audit Advisory Services and assisting as necessary in their audit process.

Essential Duties and Responsibilities:

• Conduct Compliance Reviews
• Complete compliance reviews within established parameters and initiate and carry out all assigned reviews according to defined departmental policies and processes.
• Reviewing medical records and documents to abstract clinical data for HEDIS reporting.
• Integrating electronic and hardcopy data into reports.
• Preparing and presenting HEDIS compliance reports to health facility managers.
• Training and advising clinicians and care team staff on HEDIS compliance.
• Keeping abreast of HEDIS measures.
• Apply communication skills by coordinating patient services and requests, including addressing patient phone calls, telephone encounters, and patient portal queries as well as to follow up with patients after their appointments, provide appointment reminders, to follow-up on missed appointments, etc.
• Adheres to all clinic policies and procedures, as well as applicable state, federal, and other regulatory guidelines
• Maintains all necessary licensure, certification(s), including BLS. Attends annual fire and safety classes
• Attends and participates in all assigned meetings, reports, and/or committees
• Performs other duties as assigned.

Education and Qualifications

• Ex State-approved licensing and registration as a nurse (RN, LPN, or LVN)
• Current CPR (BLS) Certification
• Bilingual (in Spanish) preferred
• Extensive experience with HEDIS database entries and reporting.
• In-depth knowledge of abstracting clinical data and evaluating HEDIS compliance.
• Advanced knowledge of medical terminology, coding, and procedures.
• Extensive experience in interpreting and reporting HEDIS information, as well as training staff.
• Excellent organizational and communication skills.
• Ability to work with people of diverse cultural, educational, social, and economic backgrounds.
• Ability to work independently and a self-starter with minimal supervision
• Computer proficiency
• Experience utilizing an Electronic Medical Records (EMR) system is highly desirable

*All JWCH, Wesley Health Centers workforce members are recommended to be fully vaccinated against COVID-19.

Employee Benefits:

At JWCH Institute, Inc., we believe in taking care of those who take care of others. If you work 30+ hours per week, you’ll enjoy competitive pay and a robust benefits package that includes:

• Medical, Dental, Vision
• Monthly employer-sponsored allowance for assistance with health premiums.
• Funded Health Savings Account (up to deductible) to assist with carrier-approved medical expenses.
• Paid time off (vacation, sick leave) and 13 paid holidays.
• 401(k) Safe Harbor Profit Sharing plan.
• Mileage reimbursement.
• Short- and long-term disability plans (LTD/STD).
• Life insurance policy & AD&D, and more!

Become part of a team where your work matters. Apply today and help us change lives, one patient at a time.

Wesley Health Centers JWCH Institute is an Equal Opportunity Employer