Clinical QA Auditor

General Purpose

Responsible for the regulatory oversight of multiple facility clinical programs located in different states.

This position provides support and education for nursing clinical programs.

The primary purpose is to assist with the design and implementation of clinical audits in vital areas requiring clinical improvement and then providing support and education that ensures regulatory compliance.

The position requires collaboration between Compliance Team members and Regional Teams (RDCS, ARDCS, RAI Specialists, IP Nurses).

This includes but is not limited to training of nurses in proper daily skilled documentation, wound documentation, and risk reduction.

Recommendations will strictly adhere to Medicare guidelines and PACS Best Practices.

Essential Duties


* Supports State and Federal Regulatory Compliance with monitoring, education, and implementation of


* clinical programs while collaborating with other members of the PACS Compliance Team and local PACS Regional Team members.


* Provides Facility Trainings as needed to support local facility clinical operations


* Educates and Mentors Registered and Licensed Nursing staff as necessary for proper daily skilled


* documentation and special focus areas including PDPM active diagnosis, fall management, wound treatment, and care planning in the EMR.


* Reviews EMR and Point Right to ensure strict compliance with Medicare guidelines


* Collaborates with Legal Team to monitor high risk liability areas and assist facilities to alleviate liability risk


* Tracks and trends clinical metrics for identified risk areas


* Participates in Facility CSR, Triple Check, and other meetings as directed


* Supports administrators in achieving clinical outcomes which adhere to industry standards of care and regulatory requirements.


* Intensive auditing responsibility of pertinent clinical topics.


* Monitors for trends affecting workflow, facility liability, and risk management


* Interface with other regional personnel to promote standardization across region


* Identifies opportunities within facilities for new programs (i.e.

Certified wound treatment)


* Supports facility with clinical reviews for probes, CERTs, ADR's, and ALJ's


* Reports to Vice President of Compliance Support any concerns with compliance or lack of adherence to company best practices


* Assists with Wound Module Training in the EMR


* Provides recommendations to supervisor for opportunities to improve company


* Must be able to travel by car and/or plane when necessary to reach assigned destination in a reasonable time frame


* Must maintain confidentiality of company and patient information


* Promotes positive attitude to coworkers and to company regarding the company, its mission statement, philosophies, and goals


* Inspire others to elevate their level of commitment


* Complete ongoing education with follow up in-service to appro...