Job Summary:

The Quality AssuranceUtilization Review Analyst will perform quality assurance/utilization review duties and provide ongoing objective evaluations of important aspects of patients' care through daily review of patient charts and identification of variations in care to provide data for use in the correction of potential problems and to meet requirements of regulatory agencies.

Supervisory Responsibilities:

• None.

Duties/Responsibilities:

• Maintains confidentiality of information discovered through the quality assurance program. Conclusive proof of violation of confidentiality will be considered grounds for possible termination.
• Screens patient charts following admission and every three days thereafter to identify potentially suboptimal patterns of care using comprehensive screening methods including utilization review criteria.
• Records variations on screening sheets and interfaces with staff for follow-up.
• Collects and compiles information for special projects as requested by the quality assurance/utilization review coordinator, i.e., hospital wide quality assurance/utilization review activities.
• Refers identified or possible variations to the quality assurance/utilization review coordinator for follow-up and resolution.
• Maintains open channels of communication with utilization review physician advisors and the nursing, medical records, social service, and infection control departments to ensure continuity of care and effective discharge planning.
• Performs surveillance for infection control and other departments as directed by the quality assurance/utilization review coordinator.
• Completes requirements for acute and long-term care certification for Medicare, Medicaid, and Title V recipients.
• Keeps knowledge up to date by reading literature and participating in outside and agency continued education meetings, training, and conferences.

Required Skills/Abilities:

• Working knowledge of regulatory agencies.
• Excellent human relations and communication skills to maintain good rapport and effective working relationships with medical staff, nursing staff, and other ancillary department staff throughout the hospital.

Education and Experience:

• LPN currently licensed in the state or accredited record technician (ART) certification required.
• Minimum of three years of clinical or hospital experience preferred.
• Substantial clinical nursing experience with considerable background in medical and nursing care practices and procedures preferred.

Physical Requirements:

• Prolonged periods of sitting at a desk and working on a computer.
• Must be able to lift up to 15 pounds at times.