Quality Safety Clinician

2 weeks ago

Lebanon, United States Hartford HealthCare Full time

Description

Job Schedule: Full Time
Standard Hours: 40
Job Shift: Shift 1
Shift Details:

Hartford HealthCare at Home is looking for a Quality Safety Clinician to manage the review of clinical documentation and assists in the training of clinical staff to ensure accurate reimbursement, regulatory compliance and the delivery of outcome-based, cost effective care.

 Job Duties:

  • Facilitates record audits and process of care investigations, trends outcome data (satisfaction, utilization and clinical), develops and implements plans of action to ensure quality improvement, reimbursement and regulatory compliance.
  • Reviews, calculates, and analyzes identified data processed by other team members as it relates to clinical documentation and quality of care.
  • When indicated, reviews and processes certification/recertification and resumption of care orders ensuring accurate documentation and the development of an accurate plan of care with appropriate visit patterns and disciplines.
  • Identifies areas for process improvement based on quality assurance and outcome studies
  • results, and internal and external record review
  • Collaborates with clinical supervisors and other case managers to identify agency trends based on the review of documentation and to develop and implement plans to address trends.
  • Provides staff guidance in making clinical and case management decisions that are cost effective and focused on clinical outcomes and operational performance indicators.
  • Conducts education and training sessions related to utilization, reimbursement and regulatory
  • compliance.          
  • Participates in post payment reviews, compliance and claim audits, and assists with record reviews, audits and appeals as needed.
  • Participates in quality assurance audits, committees & projects as needed. 
  • Demonstrates the ability to research regulations and legal requirements on reimbursement issues and to train staff appropriately.
  • Demonstrates the ability to work well with others and to educate clearly and concisely.
  • Maintains a flexible schedule to meet the needs of the agency.

 

 

 

 

               

 

 

Qualifications

Qualifications - External

Registered Nurse with a license to practice in the State of Connecticut

Graduate of an Associates degree or diploma program in Nursing; graduate of NLN-approved BSN program, preferred

Three years clinical homecare experience. 

Managed care or case management experience required.  

Familiar with OASIS, home care regulations.  

Computer literate

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