QAPI Clinical Review RN

UnitedHealth Group•Las Vegas, NV

8h•$72,800 - $130,000•Hybrid

About The Position

The Clinical Review QAPI RN plays a critical role in supporting healthcare quality initiatives through comprehensive medical record review, analyzing data integrity and consistency of OASIS Documentation, ensuring appropriate ICD-10 dx sequencing and working with clinical staff to clarify documentation and data integrity issues. Under the direction of the QAPI RN Supervisor, develops and implements agency wide QAPI program focusing on assessment and improvement in clinical care and supporting processes and compliance with state and federal regulation. Working alongside an experienced team of clinical quality professionals, this individual will help ensure accurate and timely data collection, support compliance efforts, and contribute to improving care outcomes across the network. This role offers the opportunity to collaborate directly with providers, clinical teams, and healthcare organizations while making a meaningful impact on quality performance and patient care. This role will also have a hybrid schedule working 3 days in office.

Requirements

Current, unrestricted Nevada RN license, or temporary Nevada RN license with the ability to obtain permanent licensure upon expiration
BLS CPR certification
3+ years of clinical RN experience, preferrable in Home health setting
Medical record review and chart abstraction experience
Proven working knowledge of OASIS and ICD 10 coding
Proven knowledge of federal regulations and state licensure requirements
Proven excellent coordination and communication skills
Experience educating physicians, registered nurses, and/or clinical and non-clinical staff
Experience working with Electronic Medical Records (EMR) systems
Driver’s License with automobile in good working order and maintain personal auto insurance coverage in accordance with organization requirements
Ability to work three days in office and two days at home

Nice To Haves

Bachelor’s degree
Oasis Certification (COS-C) preferred.
Home Health ICD-10 coding certification
2+ years of clinical quality experience, preferably in Home health
HEDIS data collection experience
Experience conducting medical record audits and documenting clinical information to support quality and compliance requirements
Knowledge of healthcare quality improvement methodologies and regulatory standards

Responsibilities

Reviews all OASIS assessments to ensure timeliness, appropriateness, completeness and compliance with federal and state regulations
Utilizes OASIS variation or alert reports when reviewing OASIS data
Ensures appropriate ICD-10 coding sequencing as it relates to the Admission summary
Consults with appropriate clinical staff to clarify any data integrity issues and works with clinician to make appropriate corrections
Notifies agency leadership of problematic trends as a result of OASIS review
Works with Clinical Leadership to address trends that affect the agency’s outcome and process measure noted during OASIS review
Participates in Quality Improvement and Corporate Compliance activities as assigned
Maintains professional and technical knowledge by attending educational workshops and reviewing professional publications
Participates in Administrator on-call rotation
Assists in the development and implementation of an agency wide QAPI program via data collection, analysis, reporting, and benchmarking
Prepares and presents reports regarding QAPI activities to agency leadership
Serves as a resource for the electronic clinical information system; utilizes Southwest Medical Home Health (“Agency”) technology resources to derive performance improvement
In collaboration with Agency leadership, fosters a culture of clinical excellence via continuous assessment and quality of focus on performance improvement; acts as a resource to all levels of staff; participates in development of agency policies and processes; participates in and coordinates state and federal surveys to include corrective action plans and appropriate documentation to support Agency compliance with corrective action plans
Complete inter-rater reliability testing and required training to support consistent and accurate medical record abstraction
Perform quality improvement audits and chart reviews to identify and document required clinical information
Provide education and guidance to physicians, nurses, and other clinical and non-clinical staff on quality measures, documentation practices, and related initiatives
Collaborate with internal quality team members to drive performance improvement efforts and maintain data integrity