1+ months

Peoples Health Quality Nurse Auditor - LPN - Metairie, LA

Metairie, LA 70005
  • Job Code

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The Peoples Health Quality Nurse Auditor is responsible for receiving, extracting, reviewing, and documenting clinical information from a Member's medical record that supports the Quality Improvement / HEDIS / Stars Division measures and goals. The Auditor utilizes clinical knowledge and technical specifications review documentation and files from medical records that align with CMS, and other governing agency, clinical quality metrics. The staff nurse is responsibility for ensuring and maintaining the mission of Peoples Health as outlined in the Mission Statement.


Primary Responsibilities:


  • Improve health care quality and increase likelihood of desired health outcomes

  • Monitor performance against assigned member's gaps in HEDIS and Star measures through weekly report analysis

  • Contact provider offices to obtain necessary medical records to identify and close member gaps in care

  • Implement interventions designed to improve health outcomes specific to measures and quality improvement projects

  • Retrieve data from audits; review and update compliance with HEDIS and CMS metrics within the Member file

  • Perform provider and / or facility surveys and audits to review medical records and update Member file

  • Prepare quality documentation of requests and determinations that may ultimately prevent hospital readmission including but not limited too

  • Record review to ensure medication reconciliation is timely

  • Record review to ensure PCP has been notified timely of admission and discharge information

  • Implement activities to improve patient safety and reduce medical errors

  • Participate in provider office site reviews to ensure facility meets safety and quality standards

  • Review medical record documentation to ensure compliance with evidence - based clinical practice guidelines

  • Report any issues identified through medical record review to QI Director and Quality Referral Nurse

  • Provide and support wellness and health promotion activities

  • Interact with the member and the multidisciplinary team to establish measurable health care goals and prioritization of the member's needs

  • Support health information technology (HIT) in health care quality improvement

  • Work in coordination company - based security health information systems technology to ensure appropriate documentation of the member's care coordination and record

  • Participate in ongoing training to ensure the records are accurate and secure

  • Follow corporate instruction based on Federal and State guidance related to health information documentation and security

  • Work within company and program standards and timelines



Posted: 2019-08-02 Expires: 2020-02-15

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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Peoples Health Quality Nurse Auditor - LPN - Metairie, LA

UnitedHealth Group
Metairie, LA 70005

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