Medical Review Nurse

About the Role

At St. Croix Hospice, we guide patients and families through the end-of-life journey with compassionate care, focusing on quality of life and empowering patients to make the most of their time with dignity, comfort, and respect. The Medical Review Nurse is an experienced nurse responsible for monitoring, implementing, and evaluating processes and programs to ensure they meet regulatory, accreditation, and standards of practice.

Responsibilities

• Implement and monitor the organization’s quality assessment performance improvement (QAPI) program.
• Monitor and measure activities related to QAPI as assigned, utilizing continuous quality improvement principles and methodologies.
• Implement an established schedule for clinical record review and data collection.
• Compile, trend, and report quality data in areas such as patient care, safety, risk management, infection control, outcomes, and customer satisfaction.
• Collaborate with the nursing department to ensure documentation is complete, consistent with care, and reflects regulatory/legal requirements.
• Implement processes to monitor and evaluate safety, risk management, and infection control programs.
• Assist with mandatory in-service programs on OSHA regulations for safety and infection control as requested.
• Act as a resource to staff in identifying safety and risk management issues for patients and staff.
• Review all incident reports for completeness, risk, standard of care determination, and appropriate follow-up; trend data and make recommendations.
• Maintain current knowledge related to home care safety and infection control standards.
• Monitor organization compliance with regulatory and accreditation standards, including Medicare Conditions of Participation and CHAP standards.
• Participate in the review of policies and procedures and recommend changes to the Director of Quality Assurance.
• Act as a resource to the clinical team regarding standards, policies, and regulations.
• Maintain updated nursing knowledge and skills; assist with patient visits as needed.
• Promote self-growth and collegial relationships within the home care industry by attending educational workshops, reviewing professional publications, and participating in professional organizations.
• Review medical records to ensure compliance and standards are met across the organization.
• Review live discharges to ensure appropriateness and compliance.
• Complete audits as required by survey or self-identified to ensure compliance in medical records.
• Perform other duties as assigned.

Requirements

• Current Registered Nurse (RN) license in state(s) of practice. Nurses holding a multistate license can practice in other states without additional licenses while maintaining their RN license in their primary state of residence (PSOR). Note: Minnesota, Michigan, and Illinois are not in the Nursing Licensure Compact.
• 2+ years of nursing experience.
• Graduate of an accredited school of professional nursing.
• If driving: Valid state driver’s license, access to an automobile in good working order, automobile insurance in accordance with state and organizational requirements, and an acceptable driving record; ability to pass DHS background study.

Physical Requirements

• Pushing, pulling, lifting, and carrying up to 30 pounds; occasionally up to 50 pounds.
• Prolonged periods sitting at a desk and working on a computer.
• Ability to adapt to a variety of work conditions to ensure high-quality patient care in a home setting.
• May be exposed to infections and contagious diseases.
• Contact with patients under a wide variety of circumstances.
• May be exposed to patient elements occasionally.
• Subject to varying and unpredictable situations.
• Travel required.
• OSHA exposure category: Category I (exposure to blood, body fluids, tissues) or Category II (no exposure but may require unplanned Category I tasks).