Registered Nurse, Quality Case Manager, ( RN )

AW Health Care•O’Fallon, MO

10d•$39 - $47

About The Position

The Quality Case Manager is a registered nurse responsible for quality and clinical management tasks for patients. The role includes ensuring individual plans of care promote self-care and quality of life through efficient resource utilization, and developing, implementing, monitoring, tracking, and reporting on quality assurance projects and initiatives. The position also reviews charts to assess service utilization and regulatory compliance using quality indicators developed with administrative staff. The candidate must live within 50 miles of Saint Louis, Missouri, and be licensed in Missouri or Illinois. The position works in a home or company office setting and may provide patient care when staffing is short. It is classified as high risk for exposure.

Requirements

Graduation from an accredited school of nursing.
Current registered nurse licensure in the state or states where practicing; the description specifies Missouri or Illinois licensure for the candidate.
Good understanding of Medicare reimbursement guidelines and other third-party payors.
Good interpersonal relationship and communication skills.
Current state-issued driver’s license, current motor vehicle insurance, and a motor vehicle in working condition.
Ability to participate in physical activity.
Ability to work for extended periods while standing and engaging in physical activity.
Ability to perform extensive bending, lifting, and standing on a regular basis.

Nice To Haves

Two years of experience in home health management is preferred.

Responsibilities

Maintain knowledge of current HIPAA, regulatory, and compliance issues.
Use OASIS data and other required documentation proficiently.
Follow AW Health Care policies and procedures and use the agency’s computer software proficiently.
Assist and support staff with reconsideration of denials.
Confer with staff about documentation and identified concerns involving service utilization or regulatory compliance.
Track problems, concerns, and weak areas found in reviews; report trends and in-service needs.
Update the supervisor and field staff on trends identified through chart review.
Promote agency services and programs through public relations efforts or community activities.
Recognize limitations and consult the supervisor or designee as needed.
Attend and actively participate in staff meetings and assigned committees.
Understand and actively participate in the performance improvement program.
Design, review, update, and implement the Quality Improvement Plan annually; monitor and report progress quarterly.
Coordinate quarterly peer review.
Prepare written summaries of Quality Indicator findings, including internally benchmarked standards and state and national performance indicators, and make recommendations for presentation to the Governing Body and staff.
Provide orientation, education, and direction to new personnel, students, and home care aides.
Educate staff on documentation guidelines and performance improvement related to identified deficiencies.
Ensure documentation quality for regulatory compliance, service utilization, and the timeliness and completeness of OASIS assessments, visit notes, supervisory activities, and supporting documentation.
Adhere to HIPAA regulations, educate staff on relevant HIPAA requirements, and promptly report identified non-adherence to the appropriate supervisor.
Participate in staff meetings and in-services as appropriate; complete annual mandatory in-services and maintain current CPR certification.
Perform direct patient care as directed and as staffing patterns warrant, within the scope of the nursing practice act.
Assist and support other staff in completing job duties as needed or assigned.