Quality Reviewer

Montefiore Nyack Hospital•New City, NY

16h•$93,600

About The Position

The Quality Reviewer supports Home Care’s compliance, clinical quality, and performance-improvement functions. The role conducts chart audits, monitors regulatory and payer compliance, and identifies trends that inform agency-wide quality initiatives. The reviewer completes OASIS documentation and evaluation visits, identifies documentation issues, educates staff, and collaborates with leadership to promote patient-centered care and employee engagement. The position reviews OASIS documentation and patient plans of care for accuracy, consistency with comprehensive assessments, appropriate interventions, and SMART goals aligned with applicable COP, CMS, and NYSDOH regulations. It also conducts utilization-review audits of multidisciplinary active and discharge cases, checks discharge and transfer documentation, and provides follow-up education based on audit findings. The reviewer may participate in special projects and perform other duties as assigned.

Requirements

Bachelor’s or master’s degree required.
At least three years of clinical experience in home health care required.
Working knowledge of OASIS, PDGM, EVV systems, and Medicare/Medicaid home care regulations required.
Proficiency in Microsoft Office applications required.
Analytical skills required.
Excellent written communication skills for audit findings and staff feedback.
Detail-oriented, with the ability to manage multiple concurrent chart reviews.
RN, PT, OT, or related clinical license required.

Nice To Haves

Prior quality reviewer, utilization management, or care management experience preferred.
OASIS certification preferred.
Comfort with Excel and reporting tools.

Responsibilities

Process Start of Care, Resumption of Care, and recertification OASIS documentation and patient plans of care, checking accuracy, consistency, interventions, and SMART goals against applicable requirements.
Complete utilization-review chart audits for multidisciplinary active and discharged cases to assess patient care, service use, and compliance with regulations, policies, and processes.
Review discharge and transfer OASIS documentation and summaries for accurate status capture, complete documentation, and timely submission.
Provide staff education and follow-up concerning learning opportunities identified through audits and documentation review.
Participate in special projects and perform other duties as assigned.
Participate in activities supporting the hospital’s mission and department- or hospital-wide process and outcome improvement.
Complete assigned projects within expected time frames and participate in committees and task forces as requested.
Assist with orientation for new hires.
Use equipment and supplies prudently and follow the charge process for supplies and equipment.
Maintain professional knowledge and comply with applicable licensure or certification requirements and annual competency assessment.