Quality Review Specialist needed for our Sarasota location.
Every day is an opportunity for our associates to deeply connect with people in a profound and personal way. Our associates are the core of our mission and we know that offering them genuine rewards and heart filling job satisfaction is the key to our success as a company. Here you'll find opportunities to grow your career at any level whether you have direct contact with resident or support someone who does, and be inspired personally. With over 60,000 associates, there's a place for you to make a difference in lives of the families we serve throughout our continuum of care.
Responsible for the timely review of OASIS time points in the electronic medical record to ensure accuracy of OASIS items, documentation, coding, and utilization for quality and outcome management through clinician collaboration and implementation of best clinical practices. Responsible for training and development of clinical staff, in collaboration with Quality Support Specialist (QSS), network Home Health Directors (HHD), Directors of Clinical Services (DCS), and Clinical Managers (CM), in OASIS outcomes and utilization.
Maintains accurate and timely review of OASIS time points and all related interdisciplinary documentation via the workflow in the electronic medical record (EMR) for timely OASIS locks and submission to the Centers for Medicare and Medicaid (CMS). Participates in conferences via phone, email, or fax with the Clinical Manager and/or Home Health clinicians regarding OASIS, Coding, utilization, or Plan of Care inconsistencies for appropriate corrections. Attains approval from the clinician prior to making changes to the OASIS, coding, or documentation. Utilizes available tools and develops training strategies to improve outcomes. Collaborates with Regional, Divisional and Corporate support resources as needed for strategies. Develops training based on evaluated competencies in documentation and clinical practice, edits from Strategic Healthcare Programs (SHP) alerts, and SHP reports for specific outcomes, adverse events, and utilization reports in conjunction with the Quality Support Specialist (QSS), Director of Clinical Services (DCS) and Home Health Director (HHD). Consistently demonstrates sound judgment and communication in the day-to-day operations and interactions with co-workers, management staff, and customers including on-going communication regarding patient care with physician, referral sources, care givers, patient, and community management and associates to facilitate coordination of care. Participates in all agency compliance activities. Facilitates initiatives to improve quality outcomes and agency ratings. Participates in training specific to OASIS, Coding, utilization, and documentation. Adheres to established confidentiality standards as required by Brookdale Healthcare Services and HIPAA concerning community and patient information.
This job description represents an overview of the responsibilities for the above referenced position. It is not intended to represent a comprehensive list of responsibilities. An associate should perform all duties as assigned by his/her supervisor.
Education and ExperienceBachelor's degree in Nursing, Science, or other related field and minimum three years of Registered Nurse experience, of which two years are within licensed and certified (Medicare) home health or equivalent combination of education and experience required.
Certifications, Licenses, and Other Special RequirementsCurrent/Active Registered Nurse (RN) License required. OASIS Certification, COS-C or HCS-O preferred, and other coding certification appropriate to which associate will be working. Willingness to complete OASIS and Coding certifications within 12 months of employment if experienced without credentials. Willingness to complete all assigned online training as identified to enhance skill set.
Management/Decision MakingUses limited independent judgment to make decisions based on precedents and established guidelines. Solves problems using standard procedures and precedents. Knows when to refer issues to supervisor and when to handle them personally.
Knowledge and SkillsHas a working knowledge of a skill or discipline that requires basic analytic ability. Has an overall understanding of the work environment and process. Has a working knowledge of the organization. Extensive clinical knowledge and proficiency in Nursing, Physical, Occupational and Speech/Language Therapy. Competent in Medicare home health regulations, state home health regulations, documentation requirements, ICD-10 coding, OASIS and PPS. Demonstrates the ability to make appropriate judgments based on sound knowledge of nursing principals, procedures and elements of patient teaching. Demonstrated ability to manage defined systems and processes within the Home Health agency. Basic computer software skills including Microsoft Word and Excel. Ability to respect the privacy of patients and to refrain from discussing their personal situations and problems with others, particularly as it may relate to their health. Excellent verbal and written communication skills with patients and staff. Willingness and ability to assist in planning and executing evacuation of patients during emergency situations. Ability to communicate perceived needs of patients to other skilled staff to assist with addressing their care needs.
Physical Demands and Working Conditions
Use hands and fingers to handle or feel
Reach with hands and arms
Climb or balance
Stoop, kneel, crouch crawl
Talk or hear
Taste or smell
Ability to lift: up to 50 pounds
Requires interaction with co-workers, residents or vendors
Occasional weekend, evening or night work if needed to ensure shift coverage
Possible exposure to communicable diseases and infections
Possible exposure to blood-borne pathogens
Possible exposure to various drugs, chemical, infectious, or biological hazards
Subject to injury from falls, burns, odors, or cuts from equipment
Requires Travel: Occasionally
Brookdale is an equal opportunity employer and a drug-free workplace.
Brookdale Senior Living