Registered Nurse, Quality Case Manager, ( RN )

Aging Well Health Care • St. Louis, MO

10d

About The Position

The Quality Case Manager is a registered nurse responsible for quality and clinical management tasks for patients. The role ensures individual plans of care promote self-care and quality of life through efficient resource utilization. The position develops, implements, monitors, tracks, and reports on quality assurance projects and initiatives, and reviews charts to ensure appropriate service utilization, patient care, 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. AW Health Care is a St. Louis-based, independently operated, women-owned home health agency serving patients in Missouri and Illinois. The position reports to the Manager, Quality Assurance and works in a home or company office setting. Patient care may be performed as needed during short staffing. The position is classified as high risk for exposure.

Requirements

• Graduation from an accredited school of nursing.
• Current registered nurse licensure in the state or states in which practicing; the posting specifies Missouri or Illinois licensure and also lists current Missouri licensure as a qualification.
• Live within 50 miles of Saint Louis, Missouri.
• 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 coverage, and a motor vehicle in working condition.
• Ability to participate in physical activity; work for extended periods while standing and engaged in physical activity; and perform extensive bending, lifting, and standing regularly.

Nice To Haves

• Two years of experience in home health management preferred.

Responsibilities

• Maintain knowledge of current HIPAA, regulatory, and compliance issues.
• Maintain knowledge and proficiency regarding OASIS data, required documentation, and AW Health Care software programs; adhere to agency policies and procedures.
• Assist and support staff in reconsideration of denials.
• Conference with staff as needed about documentation and identified concerns in service utilization or regulatory compliance.
• Track problems, concerns, and weaknesses found in reviews; report trends and in-service needs, and update the supervisor and field staff on chart-review trends.
• Promote agency services and programs through public relations efforts or community activities.
• Recognize limitations and consult with the supervisor or designee as needed.
• Attend and actively participate in staff meetings, assigned committees, and 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 against internal benchmarks and State and National performance indicators, and recommend findings 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.
• Assure documentation quality for regulatory compliance, service utilization, and timeliness and completeness of OASIS assessments, visit notes, supervisory activities, and supporting documentation.
• Adhere to HIPAA regulations, educate staff on applicable 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.
• Provide direct patient care as directed and as staffing patterns warrant, within the scope of practice under the nursing practice act.
• Assist and support other staff in completing job duties as needed or assigned.

Benefits

• Medical insurance
• Dental insurance
• Vision insurance
• 401(k) with 4% match
• Paid time off
• Supplemental benefit options including life insurance, short-term disability, accidental death and dismemberment, critical illness, and hospital indemnity

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level