1. Licensed as a Registered Nurse and 1-2 years of homecare experience required.
2. Working knowledge of OASIS and ICD-9 coding. OASIS certification strongly preferred; OASIS certification must be obtained within 18 months from date of hire. Home health ICD-9 coding certification preferred.
3. Knowledge of federal regulations and state licensure requirements.
4. Excellent oral and written communication skills.
5. Working knowledge of computer systems.
6. Excellent time management and organizational skills.
7. Ability to adapt to changing organizational needs.
8. Demonstrated ability to motivate and educate others.
9. Excellent customer service skills.
10. Detail oriented and able to work independently to meet deadlines.
Job Description Summary:
The Clinical Review Specialist is responsible for prospective review of all OASIS assessments ensuring all services and documentation meet the organizations standards and state and federal guidelines. Monitors for appropriate visit frequency and duration as per care guidelines.
Essential Job Functions/Responsibilities:
A. Prospective review of OASIS assessments to include: Start of Care, Resumption of Care, Re-certification, follow-ups and add-ons to ensure appropriateness, completeness, and compliance with state and federal regulations.
B. Ensures appropriate ICD-9 Coding and sequencing as it relates to the patient’s medical condition, including any co-morbidities and current guidelines.
C. Consults with the appropriate clinician to clarify any data integrity issues and/or corrections to documentation; documents same in the medical record.
D. Assists clinicians in establishing immediate and long-term therapeutic goals, in setting priorities and in developing the plan of care.
E. Reviews visit utilization for appropriateness as per care guidelines and patient condition;
F. reports potential financial losses and/or underutilization to the Clinical Manager/designee
G. Notifies agency leadership of problematic trends noted in OASIS documentation as a result of Oasis review.
H. Stays informed about changes in the field of home health care, including state and federalregulations. Attends conferences as assigned and shares that information with agency staff as appropriate.
I. May assist with other chart audit activities as needed.
J. Maintains a specific productivity standard as monitored by the Clinical Services Manager.