Home Health Care Quality Assurance Nurse (RN)
Supports the efforts of the agency in managing quality of clinical care, utilization, documentation, outcome and process management through education, associate interaction and electronic review of patient records and reporting systems. Assisting the Director in training and development of clinical staff in OASIS and documentation competencies are critical components of this role. Responsible for outcome management through implementation of best clinical practices and working within a team environment.
Education and Experience for Quality Assurance Nurse (RN):
- Registered Nurse (RN) actively licensed and good standing in the State of Michigan.
- Competent in Medicare home health regulations, state home health regulations, documentation requirements, ICD-10 coding, OASIS and PPS.
- Demonstrates the ability to make appropriate judgments based on sound knowledge of nursing principals, procedures and elements of patient teaching.
Certifications, Licenses, and other Special Requirements
- OASIS Certification, COS-C or HCS-O preferred, and other coding certification appropriate to which associate will be working.
- Willingness to complete certifications within 6- 12 months of employment if experienced without credentials.
- Willingness to complete all assigned online training as identified to enhance skill set
- Completes the clinical documentation reviews of all clinicians involved in the care of patients in a timely manner as part of the process involved with the electronic documentation system. Timely benchmarks established by the company will be followed. Confers via phone or fax with the Home Health Clinicians as to OASIS inconsistencies or incorrect coding for appropriate corrections to the documentation. Attains approval from the clinician prior to making changes to the OASIS or coding.
- Reviews and analyzes the Plan of Care for accuracy, completeness, appropriate content, and appropriate visit utilization. Discusses suggested changes or edits with RN and/or therapist. Attains approval from the clinician prior to making changes within the EMR.
- Utilizes available tools and helps develop training strategies to improve outcomes. Collaborates with Administrator, Director and Training Team resources as needed for strategies.
- Helps develop training based on evaluated competencies in documentation and clinical practice, edits from SHP alerts, and SHP reports for specific Outcomes, Adverse Events, and Utilization Reports in conjunction with Director of Quality Assurance.
- Participates in processes such as Face to Face, Case Conference, verbal orders, and medication changes.
- Runs operational and compliance reports weekly and monthly as directed by the Quality Assurance Director.
- Consistently demonstrates sound judgment and 1440 caliber communication in the day-to-day operations and interactions with co-workers, management staff, and customers including on-going communication regarding patient care with physician, referral sources, care givers, patient, and community management and associates to facilitate coordination of care.
- Executes physician’s orders and keeps the physician informed of all pertinent information concerning the patient’s condition in response to treatment. Participates with the care team and documents coordination within the clinical record.
- Participates in all agency compliance activities.
- Assists and participates in Continuous Quality Improvement Program.
- Participates in training specific to OASIS, Coding and documentation. Occasional, but rare, travel may be required to other agency or field sites as assigned to provide education, training and working one-on-one.
- Adheres to established confidentiality standards as required by CorsoCare and HIPAA concerning community and patient information.
- Other duties as assigned.