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Quality Safety Clinician
4 months ago
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
