Quality Assurance Nurse

1 month ago

South Portland, United States Northern Light Health Full time

Northern Light Home Care and Hospice

Department: Quality Management

Position is located: Northern Light Home Care & Hospice So Portland

Work Type: Full Time

Hours Per Week: 40.00

Work Schedule: 8:00 AM to 5:00 PM

Summary:

The Quality Assurance Nurse exercises independent judgement in analyzing clinical documentation to optimize accuracy with Oasis and other standardized assessment points, accurately establishing diagnoses codes to maximize reimbursement, and ensuring compliance with agency established standards of care, clinical orders and State and federal regulations. The Quality Assurance Nurse collaborates with staff, Clinical and General Education leadership, and department leader to identify areas needing improvement at the staff and agency level regarding outcome and regulatory compliance. Provides patient care as needed.

Responsibilities:

* Analyzes clinical documentation (including OASIS documentation), coding and diagnoses for accuracy while maximizing appropriate reimbursement for the organization
* Utilizes critical thinking and organizing skills to ensure the timely processing of all SOC/ROC, re-certification, and resumptions of care and discharge assessments
* Reviews OASIS for completeness and accuracy on admissions, re-certifications, resumptions of care and discharges and communicates needed changes to appropriate staff
* Collaborates with others to review CMS additional documentation requests, monitor for trends and reports to clinical leaders
* Reviews documentation and accurately applies diagnoses codes
* Problem solves and troubleshoots documentation for coding discrepancies, logical inconsistencies, errors, and completeness
* Collaborates with billing staff to resolve diagnoses coding issues
* Makes corrections in electronic health record as needed
* Maintains productivity at or above national benchmarks
* Other Duties As Assigned

Other Information:

* Valid driver's license with reliable transportation and agency required auto liability insurance. Must be able to drive within assigned region as directed
* Certification (or willing to obtain within six months of hire) as an OASIS Specialist-Clinical by the OASIS Certificate and Competency Board
* Certification (or willing to obtain within one year of hire) as a Home Care Coding Specialist-Diagnosis
* BLS for Healthcare Providers certification is required to be obtained prior to independent visits.

Competencies and Skills

* 2+ years of relative work experience required.2 Years of Clinical experience, one of which is in home health or hospice care
* Achieves Results: Sets high standards for their own outcomes and seizes opportunities to engage others towards objectives. Consistently moves forward with direct actions in order to attain or exceed objectives. Manages their own time effectively to accomplish assigned tasks. Successfully prioritizes multiple projects and duties as needed.
* Basic Life Support
* Behaves with Integrity and Builds Trust: Acts consistently in line with the core values, commitments and rules of conduct. Leads by example and tells the truth. Does what they say they will, when and how they say they will, or communicates an alternate plan.
* Cultivates Respect: Treats others fairly, embraces and values differences, and contributes to a culture of diversity, inclusion, empowerment and cooperation.
* Demonstrates Adaptability: Learns quickly when facing a new problem or unfamiliar task; is flexible in their approach with changing priorities and ambiguity. Manages change effectively and does not give up during adversity. Capable of changing one's behavioral style and/or views in order to attain a goal. Absorbs new information readily and puts it into practice effectively.
* Effectively Communicates: Listens, speaks and writes appropriately, using clear language. Communication methods are fitting to the message(s), audience, and situation and follow-ups are regular and timely. Shows that important (non-) verbal information is absorbed and understood and asks further questions to clarify when necessary. Expresses ideas and views clearly to others and has ability to adjust use of language to the audiences' level.
* Exercises Sound Judgment & Decision Making: Understands and processes complex information, which allows for appropriate and accountable conclusions. Does not react too quickly or slowly. Balances facts, goals, and potential approaches taking the appropriate criteria into account. Makes active decisions and commits oneself by communicating confidently and respectfully.
* Fosters Accountability: Creates and participates in a work environment where people hold themselves and others accountable for processes, results and behaviors. Takes appropriate ownership not only of successes but also mistakes and works to correct them in a timely manner. Demonstrates understanding that we all work as a team and the quality and timeliness of work impacts everyone involved.
* Human Capital, Supply Chain and Financial Software.
* Ability to understand the language used to precisely describe the human body including its components, processes, conditions affecting it, and procedures performed upon it.
* Word processing, spreadsheets, data entry, database experience and other computer related skills.
* MS Teams
* Multi-line phone, scanner, photocopier, fax, and internet.
* Practices Compassion: Exhibits genuine care for people and is available and ready to help; displays a deep awareness of and strong willingness to relieve the suffering of others.
* Provides Patient-Centered Care: Demonstrates understanding of patient care quality and service as organizational priority. Proactively supports change to improve patient experience and results. Exhibits the ability and willingness to find out what the patient wants and needs and to act accordingly, taking the organizational and outside resources into account. Cooperates, collaborates, communicates, and integrates care within and between teams to ensure that care is continuous and reliable.
* Zoom

Credentials

* Required Registered Nurse

Education

* Required Bachelor's DegreeIn lieu of education, two years of experience is required per year of required education, exclusive of the minimum experience identified.

Working Conditions

* Potential exposure to abusive and/or aggressive people.
* Potential exposure to diseases or infections.
* Need to drive to perform responsible duties.
* Potential exposure to noxious odors.
* Potential exposure to very hot or cold temperatures.
* Work with computers, typing, reading or writing.
* Lifting, moving and loading 20 to 30 pounds.
* Prolonged periods of sitting.
* Work beyond the regularly scheduled hours.
* Lifting, moving and loading less than 20 pounds.

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