QAPI Clinical Review RN

Primary Responsibilities

• Reviews all OASIS assessments to ensure timeliness, appropriateness, completeness and compliance with federal and state regulations
• Utilizes OASIS variation or alert reports when reviewing OASIS data
• Ensures appropriate ICD-10 coding sequencing as it relates to the Admission summary
• Consults with appropriate clinical staff to clarify any data integrity issues and works with clinician to make appropriate corrections
• Notifies agency leadership of problematic trends as a result of OASIS review
• Works with Clinical Leadership to address trends that affect the agency's outcome and process measure noted during OASIS review
• Participates in Quality Improvement and Corporate Compliance activities as assigned
• Maintains professional and technical knowledge by attending educational workshops and reviewing professional publications
• Participates in Administrator on-call rotation
• Serves as a resource for the electronic clinical information system; utilizes Southwest Medical Home Health ("Agency") technology resources to derive performance improvement
• In collaboration with Agency leadership, fosters a culture of clinical excellence via continuous assessment and quality of focus on performance improvement; acts as a resource to all levels of staff; participates in development of agency policies and processes; participates in and coordinates state and federal surveys to include corrective action plans and appropriate documentation to support Agency compliance with corrective action plans
• Completes inter-rater reliability testing and required training to support consistent and accurate medical record abstraction
• Performs quality improvement audits and chart reviews to identify and document required clinical information
• Provides education and guidance to physicians, nurses, and other clinical and non-clinical staff on quality measures, documentation practices, and related initiatives
• Collaborates with internal quality team members to drive performance improvement efforts and maintain data integrity

Required Qualifications

• Current, unrestricted Nevada RN license, or temporary Nevada RN license with the ability to obtain permanent licensure upon expiration
• BLS CPR certification
• 3+ years of clinical RN experience, preferrable in Home health setting
• Medical record review and chart abstraction experience
• Proven working knowledge of OASIS and ICD 10 coding
• Proven knowledge of federal regulations and state licensure requirements
• Proven excellent coordination and communication skills
• Experience educating physicians, registered nurses, and/or clinical and non-clinical staff
• Experience working with Electronic Medical Records (EMR) systems
• Driver's License with automobile in good working order and maintain personal auto insurance coverage in accordance with organization requirements
• Ability to work three days in office and two days at home

Preferred Qualifications

• Bachelor's degree
• Oasis Certification (COS-C) preferred
• Home Health ICD-10 coding certification
• 2+ years of clinical quality experience, preferably in Home health
• HEDIS data collection experience
• Experience conducting medical record audits and documenting clinical information to support quality and compliance requirements
• Knowledge of healthcare quality improvement methodologies and regulatory standards

Pay and Benefits

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).

No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives.

The salary for this role will range from $72,800 to $130,000 annually based on full-time employment.

We comply with all minimum wage laws as applicable.

OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.