Job location: Charlottesville, VA

Employment Type: Full-time
Posted data: 2022-01-23
Req: R0029478
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 and Guidelines

Please visit the UVA COVID-19 Job Requirements and Guidelines webpage prior to applying for current information regarding vaccination requirements and guidelines for employment at UVA.

The University of Virginia, including the UVA Health System which represents the UVA Medical Center, Schools of Medicine and Nursing, UVA Physician’s Group and the Claude Moore Health Sciences Library, are fundamentally committed to the diversity of our faculty and staff. We believe diversity is excellence expressing itself through every person's perspectives and lived experiences. We are equal opportunity and affirmative action employers. All qualified applicants will receive consideration for employment without regard to age, color, disability, gender identity or expression, marital status, national or ethnic origin, political affiliation, race, religion, sex (including pregnancy), sexual orientation, veteran status, and family medical or genetic information.