[Hiring] Clinical Record Reviewer - RN @Lehigh Valley Health Network

Role Description

Manages and supports quality and performance improvement by assisting staff to implement strategies that identify, prioritize, measure, and improve key clinical processes and outcomes. Reviews patient records to determine the complete, accurate, and timely documentation of all conditions that support home health/hospice care and treatment of the patient.

Job Duties

• Reviews and interprets patient records and compares against criteria to determine medical necessity and appropriateness of care.
• Consults with providers, management, and operations to ensure consistency within the application of clinical criteria.
• Utilizes clinical expertise for the review of medical records against appropriate criteria in conjunction with contract requirements.
• Maintains current knowledge of clinical indicators and compliance requirements.
• Manages tools to collect outcome data and provides regular feedback to individuals, managers, and leaders.
• Provides concurrent medical record review to assess documentation compliance. Facilitates recommended interventions.
• Reviews deficiencies in documentation with involved staff and facilitates corrective action.
• Participates in the ongoing development and implementation of an established performance improvement plan.
• Reviews orders for data entry, completeness, and appropriateness for admission to home health/hospice services.
• Promotes, obtains, and reviews appropriate documentation for any home health/hospice specific quality data.

Qualifications

• Associate’s Degree in Nursing.
• 2 years Experience as a Registered Nurse.
• Ability to work cross functionally across remote teams.
• Demonstrates a working knowledge of Medicare guidelines for hospice coverage.
• Demonstrated track record of continuous quality improvement.
• Proficient in prioritizing work and delegating where indicated.
• HCS-D - Home Care Coding Specialist-Diagnosis - Board of Medical Specialty Coding and Compliance Within 1 Year or
• HCS-O - Home Care Clinical Spec-OASIS - Board of Medical Specialty Coding and Compliance Within 1 Year or
• COS-C - Certificate OASIS Specialist-Clinical - OASIS Certificate & Competency Board Within 1 Year and
• RN - Licensed Registered Nurse_PA - State of Pennsylvania Upon Hire.

Preferred Qualifications

• Bachelor’s Degree in Nursing.
• 2 years Hospice experience and 1 year Hospice documentation experience or
• 2 years Home Care experience and 1 year Home Health OASIS documentation or
• 1 year ICD-9/ICD-10 coding experience.
• HCS-D - Home Care Coding Specialist-Diagnosis - Board of Medical Specialty Coding and Compliance Upon Hire or
• HCS-O - Home Care Clinical Spec-OASIS - Board of Medical Specialty Coding and Compliance Upon Hire or
• COS-C - Certificate OASIS Specialist-Clinical - OASIS Certificate & Competency Board Upon Hire.

Physical Demands

• Lift and carry 25 lbs.
• Frequent sitting/standing.
• Frequent keyboard use.
• Patient care providers may be required to perform activities specific to their role including kneeling, bending, squatting and performing CPR.

Job Description Disclaimer

This position description provides the major duties/responsibilities, requirements and working conditions for the position. It is intended to be an accurate reflection of the current position, however management reserves the right to revise or change as necessary to meet organizational needs. Other responsibilities may be assigned when circumstances require.

Work Shift

Day Shift

Address

1200 S Cedar Crest Blvd

Primary Location

REMOTE IN PENNSYLVANIA

Position Type

Remote

Union

Not Applicable

Work Schedule

Monday- Friday 8 hours Remote RN

Department

1004-09187 Health Center Central Business Office - CC