Quality Improvement/Intake

MEDICA HEALTH MANAGEMENT INC•Lubbock, TX

About The Position

The Quality Improvement Nurse, in accordance with policies and standards established by the Board of Directors, and under the direct supervision of the Director of Services/Nurses, develops, implements and evaluates the Continuous Quality Improvement Program and activities that support Agency's objectives in delivering quality client care services. S/he is preferably a Licensed Nurse responsible for maintaining the quality of client care in accordance to the agency’s objectives and policies, through effective planning, coordination, implementation and evaluation of the home health services provided.

Requirements

This position requires at least the following minimum requirements:
Licensed Vocational Nurse or Licensed Practical Nurse with two years of QI (quality improvement) experience preferred.
Experience in developing, implementing and evaluating continuous quality improvement programs and activities.
Ability to demonstrate self-confidence and positive attitude toward self and others.
Ability to maintain commitment and enthusiasm to goal achievement.
Attempts development and implementation of better methods.
This position requires at least the following minimum requirements:
Current and valid Nursing license in the state(s) practicing.
Graduation from an accredited School of Practical/Vocational Nursing.
Knowledgeable of Medicare and Medicaid guidelines.
Skillful in organization of work and in principles of time management.
Ability to contribute to the quality of care being rendered through constructive communication with nursing managers and nursing staff.
Good communication skills and ability to establish good rapport with other staff members.
Working knowledge of home health and/or hospice care and the principles and techniques of professional nursing and required documentation thereof.
Demonstrated ability to work with patients and employees.Demonstrated ability to work in a proactively diverse and inclusive organization.
Must have excellent written communication by writing clearly and informatively, edits work and able to read and interpret legal written information. Demonstrates accuracy thoroughness and follows through on commitments.
Must practice a high level of confidentiality and be able to effectively response to questions from employees, managers and outside entities. Must have excellent communication skills, both verbal and written. Must be able to work with others to resolve issues and maintain composure in an environment of changing priorities.
Must have knowledge of all company policies and procedures. Must be able to work on a timetable, follow instructions, responds to management direction and solicits feedback to improve performance. Should have excellent character references and solid work background. Must be able to read, write and speak English.
Must have knowledge and proficiency of office computer equipment and software. Demonstrate ability to multi task and work in a fast-paced office setting.Proven ability to cope with conflict, stress and crisis situations.
Must have and maintain a valid state driver license, have a registered and reliable vehicle that meets state law standards, and meets the insurance standards of company. Position requires travel between company sites as well as the community. Traveling by car or airplanes to local or out-of-town meetings, seminars, and conferences.

Nice To Haves

Spanish is preferred.
Preferred 1-2 years of clinical experience

Responsibilities

Conducts Quality Improvement Tasks.
Ensures quality and safe delivery of all client care services as implemented and evaluated per agency policies and procedures.
Ensures Performance Improvement Nurse Activities reflect current, identified quality of care problems.
Develops the agenda for and conducts the Quality Improvement Committee meetings in a timely manner.
At least quarterly, compiles Quality Improvement Committee minutes summarizing the QAPI Program to include logs (Grievance, Problem-Solver, Incident, Infection Control, and Hospitalization), results from clinical record, and tracking of quality indicators.
Prepares statistical reports annually and more often if requested on the following:
The scope of the Quality Improvement activities performed in comparison to the Agency's Quality Improvement plan.
Results of patient, physician, and referral source questionnaires.
A summary of patient related and employee related incidents, grievances, errors, and complaints and measures taken or suggested to prevent recurrence.
Clinical record review findings and the results of measures taken to correct deficiencies.
Participates in developing systems for evaluating home health care agency delivery.
Makes staff aware of home safety practices and provides resources to ensure the safety of the Agency's patients and staff in a timely manner.
Disseminates information regarding quality improvement activities to staff members in a timely manner.
Conducts chart audits and assists Administrator in preparing and conducting case conferences as needed.
Maintains strict confidentiality of client information and assures the confidentiality of clinical records
Consistently addresses cclient concerns in a timely manner.
Promotes and maintains an agency environment that is in compliance with federal, state and local regulatory agencies.
Participates in the development and implementation of educational programs for staff members.
Provides the in-services per the annual in-service schedule.
Assists with orientation and on-going training of all employees regarding documentation.
Works with administrative and supervisory personnel regarding home care visits to assure the high quality and proper follow-up of patient care with regard to patient needs.
Consults with physicians when necessary to ensure and maintain safe, efficient, and quality patient care.
Assists the Director of Nursing with answering phone calls pertaining to patient coordination.
Reviews all reports of complaints, errors, incidents, and grievances to ensure that they are fully documented and properly handled in the time-frame and manner specified by Agency policy.
Supervises a program for risk management which encompasses written guidelines and provides for supervision of workers on cases with risk factors, such contagious diseases, infection, AIDS, hepatitis, high tech therapies, high tech equipment and supplies, and other situations in which the patient or worker is at risk.
Participates in professional growth and development.
Projects a concerned, professional attitude toward departmental personnel.
Through record review and contact with staff, ensures that physician intervention is sought and documented when indicated.
Assists as requested in resolving tardy submission of progress notes, delays in billing, and paperwork related errors or problems.
Establishes and implements a system for discharge planning and for measuring the outcome and benefit of the care rendered by the Agency.
Monitors productivity requirements for staff on a monthly basis and participates in correcting productivity problems.
Participates in monitoring medical supplies and ensures that supplies are properly stored, cleaned or maintained, utilized, checked for expiration, inventoried, and billed.
Assists supervisors as requested in orienting, training, observing, and evaluating their staff.
Performs other duties as assigned by the supervisor.
Receives referrals from physicians, clinics, hospitals, social workers, and/or internal referrals and completes Agency intake process.
Completes the benefit check to verify eligibility and, if required, obtains authorization for requested services on all insurance and non-Medicare patients.
Obtains the admission order, the face-to-face documentation (including physician’s process note for F2F encounter), history and physical (if available), and HgbA1C results within the last 90 days prior to admission for all patient referrals with a diagnosis of diabetes.
Provides referral information to the Director of Nursing who will assign clinician to conduct evaluation visit. Notify clinician of impending evaluation visit.
Coordinates all services as a result of the admission visit. When add-on services are identified, obtains orders for all paraprofessional/additional services.
Coordinates referrals of all PT, OT, ST, and MSW as well as home health aide and DME.
Participates in case conference and takes note of patients for discharge and recertification.
Ensures ongoing authorization is obtained timely for all services provided to all patients with managed care plans.
Prints Expiring Authorization report at least weekly, more often as necesary.
Participates in federal and/or state regulatory audits, QAPI team conferences and represents agency in the community as requested.
Follows-up with hospitalized patients to ensure continuity of care.
Assists in coordinating services provided to patients.
Assists Director of Nursing with ordering of medical supplies and monitoring of inventory.
Attends case conferences as requested by the immediate supervisor.
Develops a positive rapport with all staff members and community resources affiliated with home health care services.
Demonstrates knowledge of federal, state and local rules and regulations.
Responsible for the completion, and submission of all the reports and records as required.
Establishes and maintains effective channels of communication.
Ensures confidentiality and reliability of agency’s data, records, proprietary information and intellectual property.
Demonstrates flexibility and willingness to work on other duties as assigned