[Hiring] QA Home Care Reviewer @Yale New Haven Health

Role Description

The QA Home Care Reviewer will facilitate the process of improving clinical documentation through extensive clinical documentation reviews and concurrent interactions with clinicians to fully capture a patient's condition, complications, and co-morbidities. The QA Home Care Reviewer will educate nurses, clinicians, and staff on documentation improvement opportunities, OASIS compliance, reimbursement, and relevant quality and performance improvement opportunities. The QA Home Care Reviewer will identify documentation issues related to quality of care and will seek resolution through the appropriate channels. Responsible for review of all clinical records regarding the OASIS and other clinical documentation and ensuring compliance with applicable State and Federal laws and regulations, Medicare guidance, and other policies and procedures.

Responsibilities

• Performs comprehensive clinical record reviews of start of care, resumptions of care, re-certifications, and discharge for complete and accurate clinical documentation to ensure the OASIS and/or assessment accurately reflects the patient's current health status.
• Completes reviews within designated time frames.
• Educates on OASIS requirements, clinical documentation, clinician educational training and support, and State and Federal regulatory requirements. Develops and conducts ongoing education including new team members, clinicians, and other staff.
• Provides in-person or virtual training to providers 1:1, or in small groups.
• Develops and supports strong collaborative professional relationships with peers, coding staff, clinical team members, and medical providers.
• Utilizes a compliant query process when conducting all clinical queries. Follows each query through to closure including complete documentation on ongoing follow-up activities and communication.
• Maintains proficiency in OASIS data and data capture best practices according to industry guidelines and CMS instructions.
• Prepares periodic reports/dashboards, as requested, that aid in various initiatives often with a direct impact to star ratings/quality reporting.
• Works collaboratively with clinical and administrative leadership to ensure positive and compliant program outcomes.
• Provides ongoing OASIS team learning opportunities through sharing of professional knowledge.
• Maintains integrity and compliance in all chart reviews, documentation, and queries at all times.
• Supports and implements quality measures as identified by department manager.
• Identifies opportunities for performance improvement.
• Assures home care compliance with OASIS requirements and remains current with regulatory and organization requirements to ensure accurate and thorough quality assurance reviews. Subject matter experts regarding CMS guidelines and OASIS review.
• Performs utilization review of existing clinical documents for potential under and over-utilization of services.
• Active participation in staff meetings, and other meetings as requested.
• Adheres to the practice of confidentiality regarding patients, staff, and the organization.
• Assists in other monitoring, training, special department projects or initiatives, or other needs as determined by the department leadership.

Qualifications

• Registered Nurse with active license, BSN preferred.
• HCS-D coding certification preferred.
• LPN with an active license accepted with a minimum of three years experience required in Quality Assurance in Home Health and Hospice.
• At least three (3) years of recent clinical nursing experience required. Home Health and Hospice preferred.
• Clinical expertise required.
• At least one (1) year of OASIS QA review experience required.
• Experience conducting quality assurance and continuous improvement activities.

Requirements

• RN license required.
• LPN with an active license accepted with a minimum of three years experience in Quality Assurance in Home Health and Hospice in lieu of RN license.
• HCS-D Home Care Coding Certification a plus.
• COQS (Certified OASIS Quality Specialist) or HCS-O (Certified Home Care Clinical Specialist) required within 12 months of hire.

Special Skills

• Excellent communication, negotiation, and organizational skills.
• Adaptability to a wide variety of interpersonal encounters throughout the health system and community.
• Comprehensive understanding in use of medical records to extract data.
• Working knowledge of third party and prospective payment systems relating to home care and hospice.
• Thorough knowledge of home care quality assurance process.
• Computer PC literacy required.
• Must be able to work collaboratively and independently.
• Must have keen eye for detail.
• Must be adaptable, flexible, have ability to learn quickly, use critical thinking, and be able to motivate staff.
• Strong computer skills.

Physical Demand

• Must be capable of standing, walking, and bending.
• Ability to communicate clearly and confidently to providers the program goals and documentation issues using email, in-person communication, telephone, and other written and electronic forms of communication.

YNHHS Requisition ID

174575