RN Quality Assurance Coordinator/Clinical Review Medicare Home Health
Better care and a better life for the aging is best when the patient is able to reside in the comforts of their home.
Compassionate, high quality care combined with clinical excellence is our motto at CareGivers of America, Inc. and that's exactly what our patients are entitled to. If you are looking for an opportunity to make a difference in the world of home care and you recognize the importance of delivering the best services available in the industry of home care and you happen to be looking for a place to call home, submit your resume today as we are looking for key team players to join us in providing medicare reimbursed services to those deserving the best the market has to offer.
As RN Supervisor of Clinical Review / Quality Assurance, you will:
- Review all Medicare episodic clinical records at the local level to assure appropriate documentation for reimbursement. This review includes verification of appropriate documentation, quality of care provided, visits utilization, appropriate contacts with physicians, adherence to the care plan, and evidence of communication between disciplines.
- Oversee the maintenance of clinical records and files to comply with Conditions of Participation (COPs), using measurements, as licensure, certification, and accreditation results.
- Audit charts for clinical oversight and compliance and adherence to the Medicare guidelines.
- Manage clinical activities, including patient assessments, care plan development, service level determination, on-site field visits, and the implementation/coordination/maintenance/evaluation of care plans.
- Be involved with the supervision of clinical staff. Participate in the recruitment, interviewing, selection, and orientation of team members; evaluate their performance relative to job goals/requirements; coach staff and recommends in-service education programs and ensure adherence to internal policies/standards. Manage the assignment of clinical associates.
- Ensure service quality and participates in care coordination to ensure proper communication between caregivers, patients, referral sources and payers. Discuss operational issues, update staff on new/changed regulations and review records/documentation to ensure regulatory and in-house compliance.
- Have oversight of clinical integrity of appropriate documentation, quality of care provided, visits utilization, appropriate contacts with physicians, adherence to the care plan, and evidence of communication between disciplines.
- Be accountable for financial responsibility related to budget goals through utilization, documentation, providing appropriate and accurate patient care, case mix weight, and appropriate utilization of delivery of patient care.
- Conduct and/or delegate the assessment and reassessment of patients, including updating of care plans and interpreting patient needs, while adhering to Company, physician, and/or health facility procedures/policies.
- Coordinate communication between team members/attending physicians/caregivers to ensure the appropriateness of care and outcome planning and ensures compliance through review of documentation and care coordination activities.
- Participate in performance improvement activities, maintain ongoing clinical knowledge through internal/external training programs, provide interpretation of knowledge and direction to staff.
- Identify clinical problem areas and documents deficiency trends in a proactive approach.
- Educate administrative and clinical associate staff in the correction of these deficiencies.
- Assist with quality improvement and Medicare compliance training program.
- Review OASIS documents for accuracy and completeness prior to locking and submitting data electronically. Explain and mentor clinicians and staff on COP's and on billable skilled visits.
- Educate and mentor clinicians one on one (in person or over the phone) regarding concerns, questions, accuracy of OASIS data, and other related documents, that are being reviewed.
- Facilitate the ICD-9/10 coding of the Plan of Treatment based on OASIS data and patient assessment documentation that is assessed by the Field RN while in the patient home
- Current Registered Nurse
- Minimum of three years clinical home care experience
- Minimum of one year in a clinical management role
- Knowledge of state and federal home health agency regulations/Conditions of Participation and Compliance standards and regulations
- Proven track record of clinical management, education and management of healthcare staff
- Outstanding leadership and managerial skills
- Knowledge of clinical policies and procedures and ability to implement
- OASIS certified or will be required to obtain OASIS certification within 1 year of hire
- Good organization, communication, human relations skills and reliable transportation
- Must possess the ability to lead and manage clinicians and office staff for successful patient outcomes and clinical and branch performance
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All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or national origin.
Mon, 2 Oct 2017 16:29:02 PDT