RN Home Care Quality Assurance - MetroWest  

RN Home Care Quality Assurance

Under the direction of the Director of Clinical Services, this position will work on initiatives to improve clinical through decreased hospitalizations, financial and operational performance. In this role, the Home Care Quality and Compliance Specialist will wear many hats, including data analysis, regulatory education, consulting, performance improvement and evaluation of practice.

Responsibilities include reviewing OASIS for completion and accuracy, design of plan of care, patient chart audits, and assisting with Utilization Review and other Quality Assurance initiatives. Quality assurance specialist will possess a strong knowledge of ICD coding for Home Health, have excellent verbal and written communication skills, be able to interpret medical data, and be extremely detail-oriented and priorities-focused to help us meet our ongoing Quality Management needs.

The Quality assurance specialist will possess the following qualifications:

Licensed as a Registered Nurse in Massachusetts
Five years healthcare experience with in-depth clinical knowledge to include a minimum of two years nursing experience in a home care setting.
Comprehensive knowledge of OASIS, ICD coding, and medical terminology.
Experience with ACHC survey preferred.
2-5 year experience in quality improvement in a health care setting preferred.
Highly effective communication skills with proven ability to work effectively with others in problem solving.
Ability to multi-task and handle high-volume of work.
Understanding of Patient Outcome Ratings and the relation to VBP.
Ability to train and educate field nurses in accordance to CMS patient outcomes and Value Based Purchasing Model.
Additional Information:

Reviewing and making suggested changes to SOC, ROC, RECERT, OASIS and then the corresponding Discharge OASIS with CMS Patient Outcome Ratings in mind, which go into the Value Based Purchasing Model that CMS enacted in 2016.

The successful candidate must also must be to train our nurses in this area.

The successful candidate must have at least two years of experience in this function, (expert?), and have a very good understanding how the Patient Outcome Ratings are done and how it relates to the VBPM.

Plan-of-Care production, review, and follow up according to the new CoPs.

We employ NCC as our ICD-10 coder, all OASIS are coded by them, then they sent us suggested changes and we can call them to discuss, this position would be interacting with our coding company

Assisting the Director of Clinical services in the overview patient care plans.