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Assists in planning, organizing, and directing the Quality Assurance Program of which the two main components are Medical Audit and Utilization Review within a State general hospital.

The work includes responsibility for supervision of the utilization review activity conducted on the units, assuring standardization of procedures to be followed in the abstracting and recording of data, assists in developing and coordinating efforts of professional committees toward development and revision of patient care audit and utilization review criteria. Other responsibilities include teaching computer terminal operation and maintenance necessary to complete utilization review functions. Decisions as to program administration are made in accordance with the Director. This person is immediately responsible to the Director of the Quality Assurance Program.

Examples of duties characteristic of positions in this class:

1. Assist the Director in managing, planning, and organizing the Quality Assurance Program within a State general hospital for the purpose of accomplishing goals and objective for both medical audit and utilization review.

2. Reviews utilization review data on a routine basis and designs reports from existing data to obtain statistics or verify certified action. Ex: would include evaluation of diagnosis, types of services, rendered, why certain test on patients are delayed.

3. Implements an employee evaluation procedure based on the Management by Objectives Program.

4. Coordinates orientation for all new employees by training new employees, writes outline for orientation, selection of team leaders.

5. Renders decisions on utilization of computerized reports and problems involving maintenance and operation of terminal.

6. Conducts staff meetings on weekly basis for the purpose of upgrading skills.

7. Continuously evaluates utilization review procedures to provide more effective and efficient methods of carrying out the function.

8. Coordinates responsibilities of team leaders and conducts weekly meetings for the purpose of insuring standardization of utilization review procedures.

9. Supervises the maintenance and updating of files on review data and statistics on the efficiency of the utilization review system. Ex: would include monthly reports on admission diagnosis, financial classification, profile on attending physicians, etc.

10. Makes recommendations to the Director based on experience in implementation of the utilization review process.

11. Coordinates in-service programs based on identified needs.

12. In the absence of the Director, the Assistant Director will assume responsibility of the Quality Assurance Program.

 

High school graduate and five (5) years experience in quality assurance, nursing, medical records administration or a related field, one year of which was in a supervisory or administrative capacity in Utilization Review or Medical Audit. Education in nursing, medical records administration or related fields may be substituted for experience on an equivalent time basis provided no substitution is allowed for supervisory or administrative experience.

Considerable knowledge of symptomology and treatment of illness, hospital organization and patient care process; knowledge of medical records and terminology, coding and classification of diseases; current rules and regulations relating to quality assurance, and the ability to work effectively with physicians, administrative heads and support personnel.