RN Specialist – Performance Improvement NurseEddy Visiting Nurse and Rehab Association

Trinity Health•Troy, NY

2d•$39 - $55

About The Position

The RN Specialist – Performance Improvement supports the agency’s quality, compliance, and performance improvement initiatives through clinical record review, OASIS oversight, utilization review, and documentation audits. The role promotes compliance with agency policies, regulatory requirements, accreditation standards, and payer guidelines while supporting accurate clinical documentation and quality patient outcomes. The specialist reviews OASIS assessments at Start of Care, Transfer, Resumption of Care, and Discharge; participates in payer denial responses; supports staff education on documentation standards and OASIS accuracy; monitors quality indicators; and collaborates with leadership to identify trends and implement performance improvement strategies. The position works primarily in a professional office and healthcare environment, regularly reviewing electronic health records, quality reporting systems, and regulatory documentation and collaborating with clinical and operational leadership. The pay range is $39.45–$55.20 per hour. Pay is based on experience, skills, and education. Exempt positions will be paid within the base salary equivalent of the stated hourly rates, and the range may vary by location. The organization is an Equal Opportunity Employer and states that qualified applicants receive consideration without regard to legally protected status.

Requirements

Associate Degree in Nursing.
Current Registered Nurse (RN) license in New York State.
Current CPR certification.
Valid driver’s license.
Minimum of 3–5 years of community health nursing experience in a home care setting.
Thorough knowledge of current nursing standards of practice and the New York State Nurse Practice Act.
Strong understanding of Certified Home Health Agency (CHHA) and Licensed Home Care Services Agency (LHCSA) operations.
Knowledge of Medicare and Medicaid reimbursement requirements.
Familiarity with CHAP accreditation standards and regulatory compliance requirements.
Advanced knowledge of OASIS guidance and home health quality measures.
Strong analytical and critical thinking skills, including the ability to identify trends, risks, and opportunities through data analysis.
Effective verbal and written communication skills and the ability to provide constructive feedback.
Strong organizational skills and attention to detail.
Proficiency with electronic medical records and quality reporting systems, including EPIC and SHP.
Ability to work independently and collaborate effectively with interdisciplinary teams.

Nice To Haves

Bachelor of Science in Nursing (BSN) or higher degree in Nursing.
Experience with OASIS assessment review and home health documentation.
Experience in quality improvement, chart auditing, utilization review, or regulatory compliance.
OASIS certification or advanced home health quality credentials.
Previous experience in Performance Improvement, Quality Assurance, Clinical Documentation Integrity, Compliance, or Utilization Review.
Experience preparing QAPI reports and leading performance improvement initiatives.

Responsibilities

Review Plans of Care for compliance with agency requirements and communicate necessary corrections to clinicians and supervisors.
Conduct multidisciplinary patient chart audits, including comprehensive and focused reviews, and follow through on corrective action plans.
Review OASIS assessments for accuracy, regulatory compliance, and appropriate reporting of patient outcomes and process measures.
Evaluate documentation for compliance with Medicare, Medicaid, agency, and accreditation requirements.
Monitor Potentially Avoidable Events (PAEs) and identify clinical and operational improvement opportunities.
Participate in utilization review and support payer denial management by reviewing documentation and assisting with appeals and requests for additional information.
Provide clinicians with constructive, actionable feedback on audit findings and documentation improvement opportunities.
Educate staff on documentation standards, compliance requirements, and OASIS accuracy.
Present quality and compliance education at team meetings, skills days, and other staff development programs.
Serve as a resource to clinical staff on documentation requirements, regulatory standards, and best practices.
Maintain audit tracking logs and quality monitoring databases.
Analyze audit findings and quality data to identify trends, risks, and improvement opportunities.
Use quality reporting tools, including SHP and EPIC reports, to identify high-risk and complex patient populations for review.
Assist with developing, implementing, and revising chart audit tools and quality monitoring processes.
Support QAPI initiatives and reporting activities.
Prepare quality reports and presentations for QAPI, PAC, and leadership meetings.
Collaborate with supervisors, directors, and clinical leadership to promote documentation consistency and quality outcomes.
Recommend policy and procedure updates based on audit findings and regulatory changes.
Immediately report significant compliance concerns and serious findings to appropriate leadership.
Participate in agency committees, workgroups, and organizational performance improvement initiatives.
Maintain current knowledge of federal and state regulations, OASIS guidance, accreditation standards, and agency policies.
Support the organization’s compliance program and complete required mandatory education and training.
Foster collaborative working relationships across departments and represent the agency professionally in interactions with staff, leadership, patients, and stakeholders.
Maintain professional competency through continuing education and professional development.
Perform other duties as assigned.