Clinical Analyst(Registered Nurse) - Bethlehem/Reading

Senior LIFE PACE; Bethlehem (Northampton County); On-site; USD 70,000 - 100,000; Full time

Job summary

PACE Consulting Solutions is seeking a Clinical Analyst for a full-time role. The analyst conducts medical record audits to ensure documentation is complete, compliant, and accurate, with real-time feedback to management and staff to maintain regulatory compliance.

Responsibilities include reviewing Medicare/Medicaid/federal regulations, identifying improvement areas, on-site support during audits, and leading mock audits to gauge readiness. RN licensure and PA driver’s license preferred.

Qualifications

• RN license is preferred.
• Minimum of 3 years experience in health care management and regulatory oversight.
• Valid PA driver’s license.

Responsibilities

• Review documentation to assure compliance with all Medicare, Medicaid, and federal regulations
• Identify areas of improvement, write plans of correction, and provide staff education
• Provide on-site support during regulatory audits.
• Build trusting relationships with Senior LIFE program staff through open communication and education
• Monitor development and implementation of all quality initiatives to ensure they are data driven, have measurable goals, and are aimed at maintaining or improving care based on outcome measures.
• Provide site visits to include real time auditing of center activities and member care
• Provide oversight of real time auditing completed by program staff to ensure compliance
• Schedule, facilitate and participate in mock audits of programs to gauge audit readiness and to identify areas for improvement. Provide mock audit reports and oversee remediation process

Job description

PACE Consulting Solutions is currently seeking a Clinical Analyst for a full time role. The Clinical Analyst performs medical record audit/validation processes to ensure that documentation rendered is complete, compliant, and accurate. Candidates must be well versed in all policies, procedures, best practices, and regulatory requirements. This position will provide real time feedback to management, clinical and non-clinical staff, and contracted providers to ensure compliance with all regulatory requirements.

Requirements

• RN license is preferred
• Minimum of 3 years experience in health care management and regulatory oversight
• Valid PA driver’s license

Responsibilities

• Review documentation to assure compliance with all Medicare, Medicaid, and federal regulations
• Identify areas of improvement, write plans of correction, and provide staff education
• Provide on-site support during regulatory audits.
• Build trusting relationships with Senior LIFE program staff through open communication and education
• Monitor development and implementation of all quality initiatives to ensure they are data driven, have measurable goals, and are aimed at maintaining or improving care based on outcome measures.
• Provide site visits to include real time auditing of center activities and member care
• Provide oversight of real time auditing completed by program staff to ensure compliance
• Schedule, facilitate and participate in mock audits of programs to gauge audit readiness and to identify areas for improvement. Provide mock audit reports and oversee remediation process

EOE