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Quality improvement review nurse

Five Stars At Home

This is a Full-time position in West Palm Beach, FL posted April 23, 2019.

DESCRIPTION Assists the Vice President of Quality Improvement in review of final claims prior to billing to ensure the accuracy of the content of the claim.QUALIFICATIONS1.

Licensed as a Registered Nurse in respective state.2.

Minimum of two (3) years home health care experience working as a QA/QI nurse in home health.3.

Knowledge of current Medicare Conditions of Participation.4.

Knowledge of process measures and outcomes.5.

Knowledge of Medicare Value Based Purchasing Model.6.

Experience with SHP or other softwares that provide data analytics and benchmarking reports.7.

Muse be comfortable with educating Clinical staff.8.

Knowledge of MS Word, Outlook and Excel.9.

Oasis C2 or ICD 10 certification preferred.10.

Able to work autonomously with minimal supervision.11.

Demonstrated organizational skills and detail-oriented.12.

Demonstrated time management skills.13.

Demonstrated interpersonal skills.14.

Demonstrated verbal and written communication skills.

10. Able to communicate in English. 11. Able to work as a team member.

12. Understanding of the billing and claim process for Medicare.PHYSICAL AND MENTAL REQUIREMENTS1.

Must be able to work under stress and in a fast-paced environment.2.

Must be able to work under conditions that require sitting, standing, walking, lifting, bending, reaching, pulling, fingering, grasping, talking, hearing and seeing.3.

Must be able to travel to agency-sponsored programs and meetings.4.

Reasonable accommodation will be made to accommodate a qualified individual with a disability.PERFORMANCE STANDARDS1.

Demonstrate professional conduct and ethics according to agency policy and procedure.2.

Maintain confidentiality of patient information and all Agency operations.3.

Manage the multi-disciplinary chart review process, per FSHC standards.4.

Perform patient medical chart reviews on a percentage of discharged charts according to agency policy.5.

Complete assigned workflow in the electronic medical record in a timely manner. 6.

Monitor quality improvement indicators, including but not limited to; inclusion of process measures and skilled documentation7.

Create monthly reports and submit to each branch the data accumulated based upon clinical review of the final claim.

Develop and implement plans of correction as needed for each of the necessary branches.8.

Assist Vice President of Quality Improvement in implementation and monitoring of care behaviors that improve patient outcomes.9.

Assist the Vice President of Quality Improvement and the branch Director’s of Health Services in monitoring the quality of all agency programs and documentation of the same according to agency policy.10.

Assist Vice President of Quality Improvement and the SVP of Clinical Services in implementation and maintenance of all FSHC standards.11.

Develop, coordinate and present staff education, as needed. 12.

Assist the Admin/DOHS to develop education to present at monthly staff meetings as it relates to the findings completed upon audits.13.

Maintain current knowledge of CMS and state home health regulations, OASIS, ICD-9/10 coding and FSHC standards.14.

Participate as an active member of the Corporate QI Committee, including developing agency-wide initiatives, participating in survey preparation and ensuring agency survey readiness at all times.15.

Review service agreements and face to face encounter forms for accuracy and validity. 16. Work with the Corporate Billing Office to correct OASIS transmission errors.17.

Attend team meetings, case conferences, continuing education and Corporate QI meetings as requested.18.

Perform other job duties and responsibilities as assigned by the Vice President of Quality Improvement and/or the SVP of Clinical Services.CLASSIFICATIONFull time/ ExemptEMPLOYEE ACKNOWLEDGEMENTI understand and acknowledge that this job description sets forth the basic requirements necessary to perform the job identified and is not a detailed description of all job requirements that may be needed to perform the job. Agency needs may necessitate performance of multiple other tasks duties and responsibilities, including but not limited to, assuming the responsibility of other positions in order to deliver a high quality service.I further acknowledge and understand that this job description is not all-inclusive and that the Agency reserves the right to change job requirements as needed.I understand and acknowledge that this job description is not a contract, in whole or in part, and that I am an employee at will.