UTILIZATION REVIEW COORDINATOR RN | UM HEALTH-SPARROW HOME CARE

Sparrow • Lansing, MI

9d • Onsite

About The Position

Assess and provide guidance and review to clinical staff regarding clinical documentation for accuracy as it relates to Coding, OASIS, and plan of care development according to regulatory guidelines.

Requirements

• Valid State of Michigan Nursing License
• Active American Heart Association (AHA) BLS Certification upon hire
• Minimum of two (2) years previous hospital/home care experience
• Must have experience in OASIS quality review in Home Care environment
• Experience in ICD-10 coding in Home Care environment.
• Ability to implement and follow policies and procedures in Agency and Health System.
• Ability to assure confidentiality regarding sensitive materials.
• Demonstrated excellent interpersonal/communication skills, verbal and written.
• Demonstrates ability to use a keyboard as may be required to perform the essential duties of the job

Nice To Haves

• Bachelors Degree in Nursing
• Previous direct patient care in a home care agency
• Utilization review

Responsibilities

• Participation, JCAHO standards, OASIS, and monitoring utilization of services for improving patient outcomes and agency profitability.
• Reviews plan of care and re-certification for medical necessity, clinical appropriateness, and completeness. Interprets data gathered to make recommendations for change as needed to support compliance issues.
• Conduct ICD-10 coding to ensure all regulatory guidelines are met
• Communicates with physicians, nurses, and other disciplines to establish a coordinate home care plan.
• Supports the performance improvement process through data collections as requested, by conducting chart audits and assisting in a variety of reports, using critical thinking skills.
• Conduct audits to include OASIS for accuracy, Plan of treatment review, and appropriate physician order review
• Communicates OASIS and Plan of Care edits to the appropriate caregiver in a timely manner to ensure timely completion of the OASIS to maintain regulatory compliance.
• Provide education and act as a resource to caregivers in the areas of coding, care plan development and OASIS accuracy.
• Other duties as assigned

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree