The Compliance & Training RN for the Scott & White Health Plan performs regulatory, accreditation and operational audits to document compliance with standards, operational and performance improvement objectives as outlined by management. Develops and produces actionable measurement reports and statistical data with analysis for use in gauging progress toward established goals and within regulatory compliance for multiple product lines. Facilitates and coordinates related nurse staff orientation & training activities to maintain or improve compliance and improve outcomes.
ESSENTIAL FUNCTIONS OF THE ROLE
Assists in the development of, conducts and reports on audits as assigned to assist in management's documentation of compliance with regulatory, accreditation and operational process improvement standards.
Examines and compares records and processes with required standards for accuracy and completeness in meeting currently established regulatory, accreditation and/or operational process improvement project standards. Assists in the review of new regulatory and accreditation standards on an annual or as needed basis.
Prepares summary of audit findings with appropriate notification to management of issues in a concise and well-documented format, with a gap analysis as appropriate and proposed action plans for improvement.
Conducts follow-up reviews to assess and verify effectiveness of any implemented action plans.
Communicates significant audit findings to management in a timely manner following the completion of audit tasks. Prepares and submits documentation of required follow-up reviews on previous audit results in a timely manner.
Develops and conducts effective nurse orientation and training programs on computerized operational systems and creates business practices to insure consistent performance within plan, regulatory and accreditation standards.
Collaborates with management and nurse staff to identify and assess learning needs impacting operational effectiveness.
Creates and conducts effective training programs on operational best practices to improve staff morale, member care coordination and operational efficiencies.
Assists with the timely development and revision of training materials, manuals, and evaluation materials. Maintains detailed records of training programs and participants and generates accurate statistical reports.
Develops and coordinates the presentation of continuing education activities specific to managed care principles. Prepares Rounds materials as needed to specific cases for learning opportunities in managed care principles on real-time cases.
KEY SUCCESS FACTORS General understanding of general health care modalities, therapies, terminology and equipment.
Knowledge of internal quality controls in compliance with department policies and procedures.
Ability to understand the customers point of view and take ownership of creating a solution to their issues.
Ability to apply statistical analysis to discover insights found in technical data.
Must be able to communicate thoughts clearly; both verbally and in writing.
Ability to effectively use a variety of teaching methods.
Interpersonal skills to interact with a wide-range of constituencies.
Must have critical thinking and problem-solving skills.
Ability to balance multiple demands and respond to time constraints.
General computer skills, including but not limited to: Microsoft Office, information security, scheduling and payroll systems, electronic medical documentation, and email.
Bachelors degree preferred. Prior experience as an RN in a non-clinical position such as Utilization Management / Utilization Review, Case Manager, Clinical Documentation Improvement, Nurse Educator, or Medical Records Auditor is preferred.
Our competitive benefits package includes the following - Immediate eligibility for health and welfare benefits - 401(k) savings plan with dollar-for-dollar match up to 5% - Tuition Reimbursement - PTO accrual beginning Day 1 Note: Benefits may vary based upon position type and/or level
- EDUCATION - Associate's
- EXPERIENCE - Requires at least 3 Years of Experience in Nursing
Baylor Scott & White Health (BSWH) is the largest not-for-profit health care system in Texas and one of the largest in the United States. With a commitment to and a track record of innovation, collaboration, integrity and compassion for the patient, BSWH stands to be one of the nation’s exemplary health care organizations. Our mission is to serve all people by providing personalized health and wellness through exemplary care, education and research as a Christian ministry of healing. Joining our team is not just accepting a job, it’s accepting a calling!