Clinical Review RN, Maternal Mortality

Job Title: Clinical Review RN (Maternal Mortality / Office Based Surgical Incidents)


Hours: 40 hours a week between 7:30am-5:30pm EST


Background: Must have strong clinical background in maternal health, NICU, OBGYN, L&D, Pediatrics, emergency medicine, inpatient. Must have strong writing skills.


Pay: $38.46-43.26/hr


Location: Jericho, NY (in office)


Position Details:


Looking for an RN with a strong clinical background (more details below) who has very strong written communication skills. Will be reviewing the documentation, medical records, and more to provide written clinical summaries to boards of review or other governing bodies.


The nurses will all be a part of the same team and will work between the Maternal Mortality Project & Office Based Surgical Incidents.


This individual will perform reviews of primary, preventative, and reproductive healthcare provided within school based health centers and family planning clinics, including conducting on-site observations of the clinics. The project requires an understanding and application of the associated regulations and guidelines, and use of standardized tools and databases.


DUTIES:

1. Completes all pre-review activities, including review of previous monitoring information, and review of program documentation submitted.
2. Completes hybrid monitoring activities, including review of patient records and billing, for all required components and time frames.
3. Conducts site observation and staff interviews, and notes any deficiencies.
4. Provides technical assistance to program personnel, where appropriate.
5. Completes data management tools to draft provider monitoring report in accordance with monitoring findings.
6. Tracks status of documents and reviews in databases and other shared platforms.

QUALIFICATIONS:

1. The ability to work independently, as well as in a team environment, and to prioritize reviews and projects to be completed.
2. Strong analytical and communication skills (both written and verbal).
3. Ability to gather and analyze information from records, reports, and other sources.
4. Proficient in the use of standard office technology and basic Microsoft applications including Word, Excel, and Teams.

EDUCATION & EXPERIENCE:

1. Qualified, and actively credentialed/registered in New York State
2. A minimum of two (2) years of clinical practice experience in pediatric/adolescent/reproductive health care.
3. A minimum of two (2) years of experience reviewing charts for the purpose of quality improvement or utilization review.

Maternal Mortality Project:
Reviewing case records where a maternal death occurred. This is tracked by CMS for a federal database and it is also required by NYS. When a case occurs, it will be evaluated by the review board. This candidate will be reviewing all of the clinical documentation, phone interviews (conducted by the staff) with loved ones, and all other pertinent information leading up to the death. They average about 50 cases a year and there is not a set turnaround time, but they would make sure that it is fully evaluated.


Office Based Surgical Incident Reviews:
These are faster turnarounds and are reporting up to DOH. Will review the cases where unexpected surgeries had to happen in an office setting (can be across numerous outpatient settings).


* We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).


* As a job position within our Care Management division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing financial and confidential information, access and handling of patient medical records, providing medical care inside a patient's residential address, driving, prescription and other drug access and administration, and working with vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.