Quality Review Specialist: Home Health
About The Position
The Quality Review Nurse is a professional, licensed vocational nurse responsible for analyzing data integrity and consistency of OASIS documentation and assessment processes. This position will ensure appropriate ICD-10 coding and sequencing and will work with clinical staff to clarify documentation and data integrity issues. Prospectively reviews all OASIS assessments to ensure appropriateness, completeness, and compliance with federal and state regulations and organization policy. Utilizes OASIS variation or alert reports when reviewing OASIS data. Ensures appropriate ICD-10 coding and sequencing as it relates to the patient’s medical condition, including any co-morbidities. Reviews visit utilization for appropriateness of care guidelines and patient condition; reports potential financial losses and/or underutilization to the clinical manager/designee. Notifies organization leadership of problematic trends as a result of OASIS review. Works with managers to address trends that affect the agency’s outcome and process measures noted during OASIS review. Makes OASIS inter-rater reliability visits with clinical staff. Performs other duties as assigned.
Requirements
- High School diploma or equivalent.
- One (1) to two (2) years of clinical experience required.
- Working knowledge of OASIS and ICD-10 coding.
- Knowledge of federal regulations and state licensure requirements.
- Current LVN License to practice in the State of California
- Current BLS Certification
Nice To Haves
- OASIS certification (COS-C) preferred
- OASIS Home Health ICD-10 coding certification preferred.
Responsibilities
- Analyzing data integrity and consistency of OASIS documentation and assessment processes.
- Ensuring appropriate ICD-10 coding and sequencing.
- Working with clinical staff to clarify documentation and data integrity issues.
- Prospectively reviews all OASIS assessments to ensure appropriateness, completeness, and compliance with federal and state regulations and organization policy.
- Utilizing OASIS variation or alert reports when reviewing OASIS data.
- Reviewing visit utilization for appropriateness of care guidelines and patient condition.
- Reporting potential financial losses and/or underutilization to the clinical manager/designee.
- Notifying organization leadership of problematic trends as a result of OASIS review.
- Working with managers to address trends that affect the agency’s outcome and process measures noted during OASIS review.
- Making OASIS inter-rater reliability visits with clinical staff.
- Performing other duties as assigned.
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What This Job Offers
Job Type
Full-time
Education Level
High school or GED
