HOSPITAL QUALITY ASSURANCE COORDINATOR 22062

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Coordinates and implements the operation of quality assurance and utilization review units within a State medical institution.

The work includes supervising and performing technical reviews and rendering decisions relative to pre-admissions screening, admissions necessity certification, evaluation of utilization, discharge planning, and development of criteria for evaluation of medical care. Decisions as to the necessity for admissions, extensions of stay, and services rendered patients are made in accordance with objective criteria established by an institutional utilization review committee. When decisions contrary to the plan of treatment of the attending physician cannot be resolved, the matter is referred to a physician reviewer. The maintenance and revision of data relative to quality assurance is insured through consultation and coordination with physicians, supportive and administrative staff. The work requires knowledge of the symptomology and treatment procedures for illnesses, and of Federal, State, and institutional regulations and procedures applicable to quality assurance and utilization review. Supervision may be exercised over technical and clerical subordinates engaged in assembly of data and screening of less complicated cases. Direction is received from a hospital quality assurance director or other professional or administrative director charged with the administration of the institutions quality assurance and utilization review programs.

Examples of duties characteristic of positions in this class:

Coordinates, supervises and implements quality assurance and utilization units engaged in prospective, concurrent and retrospective reviews relating to admissions request, pre-admission clinical testing, admissions necessity certification, length of stay, discharge planning, evaluation and development of criteria for evaluation.

Initiates documentation on the evaluation of admissions request prior to or within forty-eight hours of admission of the patient, assigns a tentative length of stay based on norms for the diagnosis, refers to a physician reviewer those cases requiring medical judgments.

Initiates documentation on the evaluation of request for extension of assigned length of stay prior to or by the date assigned at the admission and assigns a new review date.

Conducts medical care evaluation studies and supervises quality assurance technicians in the conduct of such studies, which involves abstracting patient medical records for criteria of care established and approved by the utilization review committee.

Assists in maintaining hospital conformity to laws, rules and regulations of Federal, State and professional regulatory groups for accreditation and certification as a provider for third party payments.

Makes recommendations regarding the revision of forms and clarification of criteria based on experience in implementation of quality assurance.

Coordinates with support personnel in admissions, the credit office and medical records department as well as professionals including physicians, nurses, dietitians, social workers and therapists in order to assure information necessary to carry out the quality assurance program.

High school graduation and four years of experience in quality assurance, nursing, medical records administration or related fields. Education in nursing, medical records administration, mental health technology or related subjects may be substituted for experience on an equivalent time basis.

Considerable knowledge of symptomology and treatment of illnesses and of hospital organization and patient care processes; knowledge of medical records and terminology, coding and classification of diseases, diagnosis and laboratory reports and their interpretation; ability to work effectively with medical professionals and support personnel; ability to make comparative judgments between documentation and established criteria.