Clinical Quality Specialist - Canton Medical Center - Full Time

Sanford Health, the largest rural health system in the United States, is dedicated to transforming the health care experience and providing access to world-class health care in America’s heartland. Work Shift: Day (United States of America) Scheduled Weekly Hours: 24 Compensation: Salary Range: $24.00 - $38.50 Union Position: No Department Details Summary Shall be a representative of nursing administration and shall perform necessary delegation and coordination of clinical, operational and managerial activities to accomplish the objectives of the assigned area(s) of nursing. Job Description Will incorporate responsibilities related to the quality risk and risk score adjustment programs. Assist with the quality improvement review and audit related to potential quality risk issues and adverse events as part of the quality risk program. Will complete chart reviews, documentation of findings, referral for medical director review and required reporting. Will perform healthcare effectiveness data and information set (HEDIS) record reviews and assist with clinical questions related to chart reviews. Must work collaboratively with internal and external departments to ensure all aspects of workflow are completed. Will review the risk score adjustment information for medical chart record requests and potential medical chart review. Manage the chart review process by reviewing the record request list, collaborating with information technology (IT) for file accuracy, coordinating the record requests with providers or vendors and collaborating with the chart review vendor, if applicable. Review the medical visit file to determine individuals requiring outreach to coordinate medical services. Assist members in the coordination of appointments for services. Required to complete tracking documentation of medical record requests, chart reviews and medical visit appointments to ensure status is current. Must be analytical and have critical thinking, problem solving and decision making skills. Must be organized and able to multi-task. Must be proficient in computer software such as Word and Excel. May included duties as a liaison for accrediting or governing agencies for services such as sleep medicine. Qualifications Graduate from a nationally accredited nursing program preferred, including, but not limited to, Commission on Collegiate Nursing Education (CCNE), Accreditation Commission for Education in Nursing (ACEN), and National League for Nursing Commission for Nursing Education Accreditation (NLN CNEA). Bachelor's degree in nursing preferred. Minimum of five years of nursing experience. Experience and knowledge of accreditation and regulatory agency standards preferred. Quality, medical coding, and/or risk adjustment experience is preferred. Currently holds an unencumbered RN license with the State Board of Nursing where the practice of nursing is occurring and/or possess multistate licensure if in a Nurse Licensure Compact (NLC) state. Obtains and subsequently maintains required department specific competencies and certifications. Certified Professional in Healthcare Quality (CPHQ) or medical coding certification preferred, but not required. Quality improvement/assurance personnel with nursing backgrounds can maintain their license without seeking additional hours based on role’s responsibilities. Sanford is an EEO/AA Employer M/F/Disability/Vet. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call View phone number on click.appcast.io or send an email to View email address on click.appcast.io. The Sanford organization owns and manages multiple distinct brands, including Sanford Health, Marshfield Clinic, and Good Samaritan, as well as Lewis Drug, Sanford Health Equip, Solutions by Sanford, Great Shots, and Blue Rock Bar & Grill. Sanford Health, the largest rural health system in the United States, is dedicated to transforming the health care experience and providing access to world-class health care in America’s heartland. Headquartered in Sioux Falls, South Dakota, the organization has 53,000 employees and serves over 2 million patients and nearly 425,000 health plan members across the upper Midwest including South Dakota, North Dakota, Minnesota, Wyoming, Iowa, Wisconsin and the Upper Peninsula of Michigan. The integrated nonprofit health system includes a network of 56 hospitals, 288 clinic locations, 147 senior care communities, 4,000 physicians and advanced practice providers and nearly 1,500 active clinical trials and studies. The organization’s transformational virtual care initiative brings patients closer to care with access to 78 specialties. Learn more about Sanford Health’s commitment to shaping the future of rural health care across the lifespan at sanfordhealth.org or Sanford Health News. Good Samaritan, one of the nation’s largest nonprofit providers of senior care and services, is committed to transforming the aging experience through innovation, compassion and personalized care. As part of Sanford Health, an integrated nonprofit health system headquartered in Sioux Falls, South Dakota, Good Samaritan serves 10,000 seniors and offers access to a full continuum of care, including 94 rehabilitation and skilled nursing centers, 56 assisted living and memory care facilities, 44 independent living locations and 37 home health and hospice agencies. The senior care provider delivers services across the upper Midwest, with 70% of residents living in rural communities. Learn more about Good Samaritan’s mission and commitment to delivering high quality senior care in rural America at good-sam.com.