Recovery Centers of America at King of Prussia
Works collaboratively with all RCA partners (internal and external) to ensure policies, procedures and processes reflect compliance with all regulatory regimes in which we operate, are operationalized and actionable in terms of appropriate levels and qualifications of staff, technology/systems and other critical factors necessary to function in a compliant, safe and sound manner to the benefit of our patients and employees. Protects assets by completing nursing/medical audits; ensuring compliance with regulations and internal controls; recommending improvements in internal control structure; guiding the work of auditors.
- Provide independent nursing appraisal of risk and controls by providing reviews and interpretations of medical records.
- Applies in-depth knowledge of nursing best practice principles to determine potential issues.
- Provides feedback and nursing process improvement recommendations.
- Utilize nurse best practice principles and client specific guidelines in performance of medical audit activities.
- Review the reliability and integrity of nursing and medical operational information.
- Ensures compliance with regulations and controls by examining and analyzing medical records, reports, operating practices, and medical/nursing documentation; recommending opportunities to strengthen quality documentation.
- Audit nursing and medical documentation activities for all RCA facilities to ensure that the organization is complying with applicable local, state, and federal regulations as well as internal organization expectations.
- Ensure compliance with payor contracts by examining billing practices in comparison to medical record documentation.
- Consult on policies and procedures related to medical and nursing.
- Audit and Evaluation of organizations nursing process and procedure.
- Participate in Patient Safety and Quality reviews as well at Root Cause Analysis.
- Other duties as assigned.
Education and Experience:
- Minimum of an associate degree in Business, Healthcare Administration, Public Health or Nursing is required or equivalent related work experience.
- Experience working in a healthcare environment.
- Knowledge of regulatory and accrediting bodies and their requirements as they apply to Mental Health and Substance Use Disorder Treatment preferred.
- Minimum of 2 years’ experience in a regulatory compliance role or equivalent work experience.
- Working knowledge of Microsoft Word, Excel, and Outlook.
Customer Service: Demonstrates concern for meeting internal and external customers’ needs in a manger that provides satisfaction for the customer within the resources that can be made available.
Impact and Influence: Works effectively with and through others including those whom there is no formal authority over.
Project Management: Coordinates the diverse components of the project by balancing scope, time, cost, and quality.
Communication: Communicates well both verbally and in writing, creates accurate and punctual reports, delivers presentations, shares information and ideas with others, has good listening skills.
Work Environment: May work in a variety of environments including professional offices, clinics, hospitals, or out-patient facilities. They spend much of their time on their feet, actively working with patients.
Physical Demands: While performing the duties of this position, the employee is regularly required to talk or hear. The employee frequently is required to use hands to finger, handle or feel objects, tools or controls. The employee is occasionally required to stand; walk; sit; reach with hands and arms; climb or balance; and stoop, kneel, crouch or crawl. The employee must occasionally lift and/or move objects up to 25 pounds. Specific vision abilities required by this position include close vision, distance vision, color vision, peripheral vision and the ability to adjust focus.
Travel: Travel is expected 20% of the time and will require some out-of-the-area and overnight travel.