Clinical Record Reviewer - RN - Home Health Remote

Lehigh Valley Health Network•REMOTE IN PENNSYLVANIA, PA

8d•Remote

About The Position

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.

Requirements

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.
RN - Licensed Registered Nurse_PA - State of Pennsylvania Upon Hire

Nice To Haves

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 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
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

Responsibilities

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