Clinical Quality Specialist RN - Home Health

Compassus•Paducah, KY

3d•Remote

About The Position

The Clinical Quality Specialist is responsible for modeling the Compassus values of Compassion, Integrity, Excellence, Teamwork, and Innovation and for promoting the Compassus philosophy, using the 6 Pillars of Success as the foundation. S/he is responsible for upholding the Code of Ethical Conduct and for promoting positive working relationships within the company, among all departments, and all external stakeholders. The Clinical Quality Specialist performs centralized review of home health comprehensive assessments, plans of care and associated clinical documentation. S/he verifies that OASIS responses, the plan of care and supporting documentation are accurate, internally consistent and compliant with CMS OASIS guidance, the Medicare Conditions of Participation, accreditation standards and organizational policy, and resolves identified discrepancies in partnership with the assessing clinician and agency clinical leadership.

Requirements

Associate degree or higher
Two (2) years of clinical practice experience, including one (1) year in home health
Active and unencumbered licensure as a Registered Nurse required for review of episodes that include skilled nursing services.
Active and unencumbered licensure as a PT, OT or SLP may be accepted for team members whose assigned review is limited to therapy-only episodes.
Licensure in the state of residence and licensure or applicable compact privilege in each state served, as required by the states within the assigned portfolio.
COS-C or HCS-O certification required at time of hire or within one hundred eighty (180) days of hire for external hires, and within twelve (12) months for team members transitioning from an existing Compassus role.
Prolonged periods of sitting, standing, and walking while working at a computer conducting meetings, or performing administrative duties.
Occasional lifting, carrying, pushing, or pulling of up to 20 pounds, including luggage, presentation materials, and office equipment.
Ability to navigate healthcare environments, including patient care settings, offices, and community locations, which may involve stair climbing, bending, reaching, and extended periods of walking.
Visual acuity sufficient for reviewing reports, analyzing data, and operating standard office technology.
Effective communication skills in person, by telephone, and through virtual meeting platforms.

Nice To Haves

Bachelor's degree
Prior OASIS review, clinical documentation or home health quality assurance experience.
Prior experience with electronic medical records preferred
RN License
Active and unencumbered licensure as a PT, OT or SLP may be accepted for team members whose assigned review is limited to therapy-only episodes.
Licensure in the state of residence and licensure or applicable compact privilege in each state served, as required by the states within the assigned portfolio.
The current state requirement list is maintained by the Clinical Quality function.

Responsibilities

Completes assigned review of Start of Care, Resumption of Care, Recertification, Significant Change in Condition and Discharge assessments, plans of care and associated workflows.
Verifies that OASIS responses are supported by the clinical record and consistent with current CMS OASIS guidance and item conventions.
Reviews the plan of care for ordered disciplines and frequencies, documented medical necessity, physician information, medication review, homebound documentation and correspondence with the face-to-face encounter record.
Queries the assessing clinician when documentation does not support a response and completes final review and lock of the assessment following resolution.
Completes utilization review activities including visit utilization, LUPA risk, recertification appropriateness and hospitalization risk, and documents recommendations for agency action.
Maintains working knowledge of the Conditions of Participation, CMS OASIS guidance, accreditation standards, applicable state requirements and billing requirements for assigned agencies.
Ensures assessments are completed, corrected and submitted within required CMS timeframes.
Escalates suspected compliance concerns, patterns of documentation deficiency and potential patient safety issues through the established chain of command.
Meets established productivity, accuracy and turnaround standards for assigned review work.
Participates in inter-rater reliability review and accepts audit of own review work.
Provides feedback and education to field clinicians on accurate completion of assessment and plan of care documentation and identifies documentation trends that inform process improvement.
Partners with agency clinical leadership, field clinicians, coding partners and support teams to resolve review findings.
Works effectively in a remote team environment and participates in team meetings, learning opportunities and other educational activities as assigned.
Treats all contacts with respect, supports activities that foster customer service and caregiver satisfaction, and communicates patient care and service issues through the organizational chain of command.
Uses the electronic medical record, the clinical quality review platform and associated analytics tools proficiently, and adopts new tools and workflows as introduced.
Maintains required licensure, certification and education, and completes orientation, in-service programs and annual competency requirements.
Achieves and maintains proficiency in review across all assessment types, including Discharge OASIS review, and applies current OASIS guidance to review work.
Performs other duties as assigned.
Reviews individual patient records across an assigned portfolio of agencies and states as directed by the Clinical Quality Supervisor.
Corrects and finalizes the comprehensive assessment in accordance with the agency OASIS correction policy.