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RN QUAD (Quality, Utilization Review and Documentation)/Case Manager Job

Mayo Clinic

Rochester, MN
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Job Details

RN QUAD (Quality, Utilization Review and Documentation)/Case Manager Job

Location: Rochester, MN, US

Company: Mayo Clinic

Department: Nursing

A Life-Changing Career

Responsibilities: The Quality, Utilization Review, and Clinical Documentation Improvement (QUAD) RN provides ongoing support to Mayo Clinic Rochester and Mayo Clinic Health System medical practices with direct interaction with clinical staff in the hospital setting, including nursing and physician. Major Functions of the QUAD RN include: Utilization Review, including concurrent admission status and continued stay clinical review; communication with clinical providers to identify quality value based purchasing core measures for hospital bedded patients. Clarification and face to face education to clinical staff regarding quality metrics, and continued admission status review. Act as liaison between Clinical Documentation Improvement Specialist and physicians to ensure accurate clinical documentation to support the care provided the patient is present in the medical record. The QUAD RN partners with clinical departments to critically evaluate clinical documentation and provide appropriate feedback and education. This position requires strong independent decision making, assessment, and reasoning while determining the appropriateness of patient admission status following established admission criteria and regulations. This position requires knowledge, understanding, and continued education on current regulatory compliance requirements of Government Payers in relation to Admission Status, Clinical Documentation, and Value Based Purchasing. Educate physicians, patients, and other clinical staff regarding documentation, Quality, and Admission Status criteria and regulatory requirements and penalties. The QUAD RN documents and provides clinical review to Third-Party and Government payers to meet managed care and continued stay requirements to assure appropriate reimbursement for both Mayo Clinic and the patient and assist in appealing admission or continued stay denials from Third-Party and Government payers. Face to face interaction with Physicians and other clinical staff regarding admission status, quality value based purchasing measures, and clinical documentation. Superior verbal communication and interpersonal skills are required.

Qualifications: Graduate of a National League for Nursing (NLN) or Commission on Collegiate Nursing Education (CCNE), bachelors nursing program required. One year of experience working in a clinical setting required. Three years recent acute medical/surgical hospital nursing experience preferred. Basic Cardiac Life Support (BCLS) competency preferred.

Additional Qualifications: Must have in-depth understanding of anatomy, physiology medical terminology and disease processes. Knowledge of DRG, ICD-9-CM and CPT coding, resource management systems, electronic medical record and personal computers beneficial. Demonstrated leadership, independent problem solving, conflict resolution, critical thinking skills, and team building skills required. Must possess strong computer knowledge and skills. Excellent written and verbal communication skills are required. Analytical and organizational experience required. Must be self-motivated and able to work as part of a team with minimal supervision. Must possess the ability to work well within a creative and challenging work environment. Knowledge of CPT and ICD-9 coding desirable. Experience in the areas of utilization review, clinical documentation, value based purchasing metrics, or pre-certification preferred. Additional nursing experience in specialty area beneficial.

License or Certification: Current Minnesota RN license or current license deemed acceptable by the Minnesota State Board of Nursing.

Benefit Eligible: Yes
Exemption Status: Exempt
Compensation Detail: Education, experience and tenure may be considered along with internal equity when job offers are extended. The minimum salary every 2 weeks is approx $2,617.60, based on a full-time position.
Hours/Pay Period: 80 hours per 2 week pay period
Schedule Details:
Monday-Friday; Days; 8-hour shifts – NOT NEGOTIABLE
This is subject to change at any time however based upon business needs.

Weekend Schedule: 1 in 7 with occasional holidays – NOT NEGOTIABLEThis is subject to change at any time however based upon business needs.

Recruiter: Sarah Martin

Why Mayo Clinic? Mayo Clinic provides the highest quality patient care by placing the needs of the patient first. We are the largest integrated, not-for-profit medical group practice in the world with approximately 60,000 employees working in a unique environment that brings together the best in patient care, groundbreaking research and innovative medical education. We offer a highly competitive compensation package, which includes exceptional benefits, and have been recognized by FORTUNE magazine as one of the top 100 “Best Companies to Work For”.

Site Description: Mayo Clinic is located in the heart of downtown Rochester, Minnesota, a vibrant, friendly city that provides a highly livable environment for more than 34,000 Mayo staff and students. The city is consistently ranked among the best places to live in the United States because of its affordable cost of living, healthy lifestyle, excellent school systems and exceptionally high quality of life.

Mayo Clinic is an equal opportunity educator and employer (including veterans and persons with disabilities).

Job Posting Category: Nursing
Job Posting Number: 76759BR

Date: Jun 25, 2017

Nearest Major Market: Rochester MN

Job Segment: Physiology, Medical, Patient Care, Case Manager, Healthcare, Quality