Clinical Auditor

Overview

The Clinical Auditor oversees activities aimed at reducing variability in clinical practice and assists with the development and standardization of clinical pathways, protocols, and clinical practice guidelines. The Clinical Auditor leads clinical audit activities by facilitating system-wide improvement in the overall quality, completeness, and accuracy of the medical record documentation through extensive audit, data analysis, dissemination of audit findings or reports and education within all clinical service lines. The Clinical Auditor monitors physician practice standards, billing conduct and ensures zero tolerance for unethical practice and conduct of care.

Responsibilities

KEY DECISIONS THE ROLE MAKES AND THE EXTENT OF THE IMPACT OF THE DECISION

• Makes decisions where relevant on areas including, but not limited to, clinical practice improvement strategies, frameworks, and guidelines.
  
  

Key Accountabilities And Activities

Clinical Audit Activities

• Enables value-based care delivery by optimizing quality and cost of clinical pathways.
• Ensure all process are in place to is to meet the regulatory standards, and coding standards to support Revenue Cycle Management.
• Participates in the development of clinical audit plans, policies, and framework in collaboration with the different medical and clinical disciplines and assists in monitoring key aspects of the plan.
• Creates and maintains a clinical audit database.
• Executes audits across multiple service lines and clinical specialties to maintain oversight of compliance to clinical practice guidelines and care pathways.
• Conducts concurrent and closed medical record reviews and communicates the findings to the appropriate clinical teams.
• Reviews quality of medical record documentation and conveys deficiencies to clinical teams as necessary.
• Maintains up to date and accurate records of clinical audit activity and of resulting action plans, to effectively manage re-audit and closure of the audit.
• Facilitates the dissemination of audit results using appropriate media including posters, publications, and presentations.
• Actively participates in accreditation activities.
  
  

Evidence-based Practice

• Participates in clinical practice guideline development, during which content is created or revised through a process of reviewing published guidelines and primary literature sources.
• Identifies auditable standards within the clinical practice guidelines and aligns key performance indicators with the same.
• Facilitates content expert team meetings to develop care standards, clinical practice recommendations and evidence-based guidelines across M42 facilities.
• Participates in department and hospital committees and task forces to facilitate changes and develop processes to improve patient care utilizing evidenced based practice guidelines.
• Collects and curates’ relevant sources of evidence-based content; Present findings to content experts/work groups.
• Facilitates transition of evidence-based clinical decision support tools (i.e., order sets) into electronic health records (EHRs), and coordinates with analytics to develop reports/scorecards which track the adoption of the decision support tools.
  
  

Process Improvement

• Reviews and analyzes performance of clinical outcomes against benchmarks to identify opportunities to standardize and streamline clinical practice and processes across M42 facilities.
• Facilitates process improvements or development projects to achieve desired outcomes both in terms of clinical and business outcomes.
• Drives improved compliance to implementation of clinical practice guidelines by tracking and trending adoption metrics.
• Works in collaboration with revenue cycle management to ensure that all billing processes are optimized within the clinical guidelines to ensure appropriate revenue generation from each patient encounter.
• Works in collaboration with Case Management and Clinical Development to ensure patient referral pathways are embedded within the clinical practice guidelines.
  
  

Project Management

• Organizes and leads project teams and works collaboratively with the clinical champion(s) to meet project goals.
• Acts as a liaison between M42 facilities to guarantee project deliverables are completed on time with high quality.
• Manages project timeline, risks, and scope, and communicates status to management and stakeholders on a consistent basis.
• Recognizes clinical questions or discordant work group opinions on the best evidence-based practice; resolves conflict and drives consensus during projects, particularly when published evidence is lacking or consensus is not easily obtained.
  
  

Training and Education

• Communicates recommendations for modifications in documentation to clinical caregivers, informatics, and other relevant stakeholders.
• Provides and/or facilitates education and training of staff, and clinicians to improve quality of documentation.
  
  

Professionalism

• Ability to adapt to a variable workload and function in a deadline-oriented environment.
• Works independently and prioritizes individual tasks, makes decisions within the scope of their responsibilities while requiring minimal guidance or oversight.
• Maintains high productivity, meeting deadlines, and time frames for multiple tasks simultaneously.
• Functions as an expert, educator, consultant, researcher, facilitator, and advisor.
• Promotes an interdisciplinary team approach based on mutual respect and direct communication between healthcare professionals to ensure care is delivered effectively.
  
  

Organizational Culture & Compliance

• Reflects the mission, vision, and values of M42 and adheres to the organization’s clinical ethics standards.
• Adheres to policies, procedures and standards while ensuring compliance with applicable regulatory bodies.
• Contributes towards an innovative culture of continuous improvement for enhancing clinical efficiency and effectiveness.
• Participates in meetings and maintains professionalism and confidentiality as per the organization's standard code of conduct.
• Completes personal performance evaluation cycle in a timely manner.
  
  

Communication

• Communicates effectively with team members, remains unbiased and maintains good inter-functional liaison to ensure smooth implementation of operational activities.
• Develops relationships with key stakeholders across M42 facilities to ensure caregivers are supported by consistent safety and quality systems to continually improve clinical outcomes.
• Shares learning across assets in relation to audit findings/actions and QI projects.
  
  

Qualifications

Required:

• Medical Doctor (MBBS) or bachelor's degree in nursing science or relevant clinical field.
• Three years (3) physician, nurse, case management, or utilization review experience in an acute care setting.
• Three to five (3-5) years of experience with guideline development and demonstrated clinical audit completion.
  
  

Desired:

• Master's degree in healthcare related field
• Certified American Health Information Management Association (AHIMA)
• Documentation Integrity Practitioner (CDIP)
• Certified Association of Clinical Documentation integrity Specialists (ACDIS) Clinical Documentation Specialist (CCDS)
• Certified Professional in Healthcare Quality