Sanford Health ยท 2 months ago
Clinical Quality Assurance Specialist- SF Center- PT Day
SD, Sioux Falls
Full-time
Onsite
Mid Level
$24/hr - $38.50/hrSanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. The role involves performing necessary delegation and coordination of clinical, operational, and managerial activities to accomplish the objectives of nursing administration, focusing on quality risk and improvement. Responsibilities include conducting chart reviews, managing record requests, and collaborating with various departments to ensure workflow completion.
ChildrenEducationHealth Care
Responsibilities
Will incorporate responsibilities related to the quality risk and risk score adjustment programs
Assist with the quality improvement review and audit related to potential quality risk issues and adverse events as part of the quality risk program
Will complete chart reviews, documentation of findings, referral for medical director review and required reporting
Will perform healthcare effectiveness data and information set (HEDIS) record reviews and assist with clinical questions related to chart reviews
Must work collaboratively with internal and external departments to ensure all aspects of workflow are completed
Will review the risk score adjustment information for medical chart record requests and potential medical chart review
Manage the chart review process by reviewing the record request list, collaborating with information technology (IT) for file accuracy, coordinating the record requests with providers or vendors and collaborating with the chart review vendor, if applicable
Review the medical visit file to determine individuals requiring outreach to coordinate medical services
Assist members in the coordination of appointments for services
Required to complete tracking documentation of medical record requests, chart reviews and medical visit appointments to ensure status is current
Must be analytical and have critical thinking, problem solving and decision making skills
Must be organized and able to multi-task
Must be proficient in computer software such as Word and Excel
Qualification
Required
Must work collaboratively with internal and external departments to ensure all aspects of workflow are completed
Must be analytical and have critical thinking, problem solving and decision making skills
Must be organized and able to multi-task
Must be proficient in computer software such as Word and Excel
Preferred
Graduate from a nationally accredited nursing program preferred, including, but not limited to, Commission on Collegiate Nursing Education (CCNE), Accreditation Commission for Education in Nursing (ACEN), and National League for Nursing Commission for Nursing Education Accreditation (NLN CNEA)
Bachelor's degree in nursing preferred
Benefits
Competitive Compensation
Direct access to your earnings daily
Shift Differential
Flexible Scheduling Options Available
Fun, Family Oriented Work Environment
Excellent Health, Dental and Vision Insurance
Health Savings Account
Company Matched 401(k) Retirement Plan
Paid Time Off
Salary Increases
Referral Bonuses
Advancement Opportunities
Compassionate Leave
Education Assistance
Scholarships and Sponsorships
Continuing Education
Years of Service Recognition Program
Company
Sanford Health
Sanford is a healthcare company providing research, education and clinical care.
Founded in 1894
10001+ employees
H1B Sponsorship
Sanford Health has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (26)
2024 (37)
2023 (38)
2022 (51)
2021 (64)
2020 (30)
Funding
Current Stage
Late StageLeadership Team
Baier Roger
CEO
Bill Gassen
President & Chief Executive Officer
Recent News
2025-11-20
2025-11-01
Company data provided by crunchbase