Remote Case Management Jobs in Sumter, SC (NOW HIRING)

Inspire health. Serve with compassion. Be the difference.
Job Summary
Responsible for collection, validation and clinical quality review of patient-level data for national clinical quality initiatives (i.e., CMS core measures) or other clinical data registries (i.e. heart failure, cancer, stroke, etc.) necessary to support mandatory reporting, specialty centers of excellence, accreditation or certification requirement. The scope of the clinical data abstractor work involves managing the overall medical record retrieval process for abstracting the required data; collecting numerous complex data elements using established definitions; ensuring the integrity of the electronic data transmitted to an established national database/registry; preparing and interpreting clinical data reports and working with clinical team members on quality improvement projects. Translates clinical documentation into information that can be used for actionable improvement; recognize and identify variances between and within systems, evaluate potential causes of variation and work collaboratively to support action plans for clinical care improvement. Supports the organization/market/campus or care setting's clinical and administrative leadership team, quality leadership, subject matter experts (SMEs), stakeholder groups and ad hoc teams related to data abstraction and performance improvement. Provides guidance, consultation, and standard work for the design and maintenance of registry and clinical databases.
Essential Functions

• All team members are expected to be knowledgeable and compliant with Prisma Health's purpose: Inspire health. Serve with compassion. Be the difference.
• Abstracts clinical data elements from the electronic medical record per guidelines/ definitions of the patient-selection criteria and sponsoring/regulatory entity (e.g. CMS Core Measures) or clinical-related databases or registries; develops efficient data collection and data management processes; ensures data integrity through validation and clarification of case questions; maintains proficiency and productivity in terms of volume of patient records assessed and abstracted.
• Uploads/submits data files to sponsoring organization and investigate/correct data submission errors; work with key stakeholders to resolve questions, issues or problems related to software, report capacity, benchmarking reports, etc.
• Fosters collaboration between abstraction staff and clinical leaders to achieve the required results for quality patient care and accurate documentation for data abstraction and submission.
• Meets with specific clinical stakeholders to report on quality outcomes, performance and compliance results.
• Performs detailed medical record review when deviation or non-compliance with practices is determined; identifies trends and patterns; provides feedback to key stakeholders.
• Performs other duties as assigned

Supervisory/Management Responsibilities

• This is a non-management job that will report to a supervisor, manager, director or executive.

Minimum Requirements

• Education - Associate degree. Preferred education in one or more of the following areas: Healthcare related field, Health Information Management or related field of study.
• Experience - Two (2) years clinical data abstraction, data management or data entry experience preferred.

In Lieu Of

• In lieu of Associate degree, experience in data abstraction with five (5) or more years directly related work experience will be considered.

Required Certifications, Registrations, Licenses

• If working with Cancer registry, an Oncology Data Specialist Certification, effective 1/1/2024, by the National Cancer Registrars Association (NCRA) is required within one year of employment in the role.

Knowledge, Skills and Abilities

• Proficient computer skills (word processing, spreadsheets, PowerPoint database, data entry)
• Mathematical skills
• Knowledge of electronic health records
• Working knowledge of quality improvement, clinical data review, and performance improvement methodologies
• Ability to effectively communicate opportunities for improvement.
• Detail oriented
• Ability to work independently and to adhere to standards/definitions of sponsoring agencies/ entities
• Communication skills and ability to interact and build relationships within quality improvement teams.
• Ability to utilize appropriate resources to make decisions regarding data abstraction, interpretation and dissemination.
• Knowledge of human anatomy, medical terminology, electronic medical record, data abstraction/data entry.

Work Shift
Variable (United States of America)
Location
Richland
Facility
Corporate
Department
Clinical Care Experience - Clinical Data Management
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