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Clinical Quality Reviewer RN / Seton Medical Center Austin / Cardiology Oth Svcs Anc 001 / FT D

Seton Medical Center Austin
Seton Healthcare Family
Type Full time Posted 3/11/2014
Salary - n/a - Starts 7/21/2014
TX - Texas (All) - Austin Referral - n/a -    
Clinical Quality Reviewer RN / Seton Medical Center Austin / Cardiology Oth Svcs Anc 001 / FT Days
27664
TX - Austin
Full-Time
Regular


Additional Job Information

Title: Clinical Quality Reviewer RN

City, State: Austin, TX

Location: Seton Medical Center Austin

Department: Cardiology Oth Svcs Anc 001

Additional Job Details: FT Days

Marketing Statement
Seton Healthcare Family offers rewarding and diverse career opportunities, superior benefits and excellent options for personal growth. Seton is always looking for dedicated and skilled individuals willing to share their hearts with those we serve.
 
The Seton Healthcare Family, a member of Ascension Health, is the leading provider of healthcare services in Central Texas, serving an 11-county population of 1.8 million. The network includes five urban acute care hospitals, two rural hospitals, a mental health hospital, several strategically located health facilities that provide medical care for well patients and three primary care clinics for the uninsured. Four out of every ten overnight patients in the region receive their care at a Seton facility.

With more than 13,000 associates, Seton is the largest private employer in Central Texas and the only not-for-profit organization among the top 25 employers in the Austin area. In addition, Seton is home to four Magnet nursing facilities-University Medical Center Brackenridge, Dell Children's Medical Center of Central Texas, Seton Medical Center and Seton Northwest Hospital.
 
About Austin: 
 
Austin is in the heart of the beautiful Texas hill country-only a few hours from Dallas, Houston and San Antonio. Enjoy a mild climate, affordable housing and no state income tax! Plus you'll have the chance to be part of a friendly city that offers something for everyone: lively nightlife, recreational activities, colleges & universities, lakes and family-oriented fun. Rich in history, cultural diversity, natural beauty and a vibrant blend of professions, Austin is a cosmopolitan city with a down-home feel. Whatever you like, Central Texas has something to offer.
 
Apply online attoday.  EOE/AA/M/F/D/V
 
CAREERS at Seton… Not just a living… It’s a way of life!
Job Description

Summary:

The Clinical Quality Reviewer RN provides health care services regarding admissions, case management, discharge planning  and utilization review.

Responsibilities:

  • Reviews admissions and service requests within assigned unit for prospective, concurrent and retrospective medical necessity and/or compliance with reimbursement policy criteria. Provides case management and/or consultation for complex cases.
  • Assists departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals.
  • Assesses and coordinates discharge planning needs with healthcare team members.
  • Prepares statistical analysis and utilization review reports as necessary.
  • Facilitates effective implementation of quality review initiatives.
  • Develops resources for quality review process and is responsible for providing appropriate resources for all program participants.  Develops consistent process for quality review implementation and maintenance, as applicable.
  • Develops and assists with staff education as it relates to the quality improvement process.
  • Assists in the development of the quality improvement program strategic plans to include goals, outcomes and evaluation processes.  Maintains records of the current status of quality improvement initiatives.
  • Performs other duties as assigned.

Education & Experience:

  • HS or Equivalent, And, Two (2) years of clinical nursing experience is required
  • .Bachelor's or Master's in Nursing is preferred.

Licenses & Certifications:

Current license to practice nursing (RN) in the state of Texas is required or must be obtained prior to hire or job transfer date.

Equal Employment Opportunity

Seton Healthcare Family is an equal employment opportunity / Affirmative Action employer and complies with all applicable federal, state and local equal employment regulations and laws. It is the policy of the Seton Healthcare Family to afford equal employment opportunities to all employees and prospective employees without regard to their race, color, ancestry, religion, sex, sexual orientation, national origin, age, physical or mental disability, citizenship status, veteran status, gender identity or expression, or any other characteristic or status that is protected by federal, state, or local laws. This policy applies to all personnel actions, such as hiring, promotion, transfer, demotion, termination, layoff and all other conditions and privileges of employment in accordance with applicable federal, state, and local laws.

Affirmative Action goes beyond the concept of equal employment opportunity. Affirmative Action policies and programs are required to overcome the present effects of past discrimination and to achieve equal employment opportunity for members of groups that are or have been formerly under-represented. Affirmative Action policies and programs are tools whereby additional efforts are made to recruit, employ and promote qualified members of formerly excluded groups, even if that exclusion cannot be traced to particular discriminatory actions. Through specific and result-oriented activities, Seton Healthcare Family’s goals are to ensure that every person is given full consideration through equal employment opportunity policies and practices and to achieve a representative workforce through its affirmative action efforts.
 
It is further the policy of the Seton Healthcare Family to encourage vendors, contractors, affiliate institutions and others doing business with the Seton Healthcare Family to observe the principles of Equal Employment Opportunity and Affirmative Action.