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RN Quality Assurance

Company: Hope at Home Health Care
Location: Southfield
Posted on: May 14, 2022

Job Description:

Job DescriptionBecome a part of the Hope At Home Family!We currently have a position available for an experienced Home Health Care Quality Assurance RN!This position is only for an onsite location in our Southfield office and the individual will provide clinical management support throughout our service area. Must have Wellsky/Kinnser Software Knowledge to qualify for this position. We offer competitive pay. Benefits include health, dental, vision, and paid time off for full-time employees.ESSENTIAL JOB FUNCTIONS/RESPONSIBILITIES:

  • Review all Medicare and other episodic payers' clinical records to assure appropriate documentation for reimbursement. This review includes verification of appropriate documentation, quality of care provided, visit 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.
      • Provide new staff orientation and 90 day and annual in home care competency reviews.
        • Audit charts for clinical oversight and compliance and adherence to the Medicare guidelines.
          • Oversees clinical activities, including patient assessments, care plan development, service level determination, on-site field visits, and the implementation/coordination/maintenance/evaluation of care plans.
            • 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.
              • 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 at the bedside.
                                  • Collaborate with leadership to ensure effective and efficient episodic management.The above statements are intended to be a representative summary of the major duties and responsibilities performed by incumbents of this job. The incumbents may be requested to perform job-related tasks other than those stated in this description.QUALIFICATIONS:
                                    • Current Registered Nurse
                                    • EMR - Kinnser experience (WellSky)
                                    • Minimum of three years of clinical home care experience
                                    • Knowledge of state and federal home health agency regulations/Conditions of Participation and Compliance standards and regulations
                                    • Knowledge of clinical policies and procedures and ability to implement
                                    • Good organization, communication, human relations skills, and reliable transportation.

Keywords: Hope at Home Health Care, Southfield , RN Quality Assurance, Healthcare , Southfield, Michigan

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