Job Summary: Registered Nurse experienced in Home Care. Participates in the interpretation and implementationof quality assurance standards in the Certified Home Health Agency (CHHA) to ensure quality care to patients. Reviews quality assurance standards, studies existing policies and procedures, and evaluates effectiveness of quality assurance program. Participate in reviewing quality assurance policies and procedures and make suggestion for change in accordance with best practice standards. Reviews and evaluates patients’ medical records, applying quality assurance criteria. Compiles statistical data and prepares reports summarizing quality assurance findings.
1. Assists in the development and implementation of regulatory compliance standards and mechanisms for evaluation of same.
2. Reviews and lock Oasis Assessment Data Set in accordance with regulatory guidelines and agency policy
3. Reviews 485's (POC) for assure accuracy in consistency with Oasis Assessment Data Set, and educates staff on documentation requirements.
4. Participates in agency quality management and utilization review committee meetings.
5. Participates in the development of mechanisms to meet regulatory requirements for compliance with Medicare Conditions of Participation and State Regulation.
6. Collaborates with Clinical Manager to ensure compliance with Federal, State and local regulations, agency policies and procedures and accreditation standards through documentation review, clinical outcomes analysis and staff education.
7. Participates in the development of mechanisms to meet regulatory requirements as stipulated by State and City regulatory agencies.
8. Participates in internal and external team conferences and attend regulatory fiscal intermediary meetings as assigned.
9. Assists in the orientation of new personnel and ongoing education of all staff regarding regulatory compliance as it relates to Quality Management, OASIS accuracy and billing.
10. Acts as a resource to staff regarding ICD-9 coding.
11. Participate in agency wide clinical record reviews to determine appropriate documentation in accordance with regulatory guidelines, professional practice and the delivery of comprehensive quality of care.
12. Reviews with supervisor all intermediary requests for information (488s). Respond to all inquiries as directed.
13. Participates in monthly reviews of adverse events to ensure appropriate follow up.
14. Participates in the reviews of Occurrence reports to ensure appropriate follow up has been taken and review for accuracy.
15. Participates in collection, and analysis of data for the agency’s quarterly Professional Advisory Committee report and annual program review report.
16. Performs Case management activities and other duties as assigned or requested.
Knowledge, Skills And Requirements
QUALIFICATIONS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
EDUCATION AND/OR EXPERIENCE: Graduate of an accredited school of nursing; Bachelor’s degree (B.A.) in Nursing from a four-year college or university preferred.
CERTIFICATES, LICENSES, REGISTRATIONS: Must have current NYS license and registration to practice as a Registered Professional Nurse in New York State. Must be OASIS certified.
LANGUAGE SKILLS: Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients, and the general public.
REASONING ABILITY: Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
OTHER QUALIFICATIONS: Must be able to travel locally by public transportation to make home visits. Valid driver’s license, car registration and insurance as applicable.