Home Health Quality Assurance Manager (70158) at Columbia

Job Description

I believe that better care begins at home.Compassionate care, uncompromising service and clinical excellence – that’s what Gentiva® patients have come to expect fromour clinicians for over 40 years. Gentiva, America’s homecare and hospice leader, has set the clinical standard fortoday’s fastest-growing segment of healthcare – homecare. By creating innovative solutions that lead to high-qualitypatient outcomes, Gentiva’s patient-centered approach improves quality of life and independence. With Gentiva, greathealthcare has come home.

I believe I can make a difference.With over 40 years of experience and more than 420 locations in 40 states, Gentiva Home Health and Hospice servesapproximately 80,000 patients daily. Gentiva is a company on the move – driving some of the most exciting newopportunities in home health and hospice. Financially and strategically, we are positioned to be a key player in theindustry for years to come. All of which make Gentiva the place to be.

I believe in working for a company that cares as much as I do.Gentiva offers our employees a unique employment package that includes:

• Unprecedented opportunities for career growth.
• Clinical ladder for professional credentialing and advancement.
• Innovative specialties with cutting-edge training and development.
• Flexible full-time, benefited pay- per- visit, part-time and PRN positions.
• Comprehensive benefits which include competitive pay with direct deposit, medical, dental, vision, short and long termdisability, life insurance, a generous PTO package, paid holidays, 401(k), tuition reimbursement and much more.

I believe a stronger team begins with me.

As a Home Health Quality Assurance RN Manager, you will:

• Review all Medicare and other episodic payers’ clinical records at the local level to assure appropriate documentation for reimbursement. This review includes verification of appropriate documentation, quality of care provided, visits utilization, appropriate contacts with physicians, adherence to the care plan, and evidence of communication between disciplines.
• Oversee the maintenance of clinical records and files to comply with Conditions of Participation (COPs), using measurements, as licensure, certification, and accreditation results.
• Audit charts for clinical oversight and compliance and adherence to the Medicare guidelines.
• Identify clinical problem areas and document deficiency trends in a proactive approach. Educate administrative and clinical associate staff in the correction of these deficiencies.
• Assist with quality improvement and Medicare compliance training program. Utilize Gentiva Health Services approved reference materials to resolve inadequacies.
• Communicate with the Area Education Specialist regarding identified trends of deficiencies with Medicare Conditions of Participation, clinical care, coordination of care, and documentation for the purposes of requiring more extensive education or action of clinical staff.
• In accordance with the Branch Director, monitor the receipt of Medicare denials, Billing Compliance held claims, and other payer denial notices. Assess the validity of these denials, and respond with additional information. Inform the Branch Director and Branch staff of noticeable trends or relevant issues.
• In accordance with the Branch Director, prepare and file general appeals on a timely basis. Attend fair hearings as necessary.
• Collaborate with the Clinical Leadership and clinical associate staff in resolving complex clinical issues.
• Participate in the initial orientation of the clinical associate staff regarding Medicare Conditions of Participation and relevant requirements for care and documentation and provide education during the orientation in the timeliness of paperwork and flow of OASIS.
• Collaborate with branch Clinical Leadership to analyze Performance Improvement trends in the delivery of care. Keep up with the performance indicators and monitor the Performance Improvement plan for the branch. Essential in driving performance measures in the branch.
• Review OASIS documents for accuracy and completeness prior to locking and submitting data electronically. Explain and mentor clinicians and staff on COP’s and on billable skilled visits.
• Educate and mentor clinicians one on one (in person or over the phone) regarding concerns, questions, accuracy of OASIS data, and other related documents, that are being reviewed.
• Facilitate the ICD-9/10 coding of the Plan of Treatment based on OASIS data and patient assessment documentation that is assessed at the bedside.
• Collaborate with branch leadership to ensure effective and efficient episodic management, utilizing Gentiva Health Services reports such as Projected vs. Actual, PPS Unbilled and Post Billing Adjustment, to identify trends.

Job Requirements

• Bachelor’s degree in Nursing or the equivalent
• Minimum of three to five years nursing experience, including two years of home healthcare experience within the past five years
• Prior ICD-9/10 coding experience
• R.N. License
• Working knowledge of Medicare home health requirements
• Analytically inclined and detailed oriented to ensure proper and accurate coding for reimbursement

Keywords: RN Manager, Nurse Manager, Home Health Nurse, Home Care Nurse, Homecare Nurse, ICD9 Coding, OASIS, QA Nurse, QA Manager, Quality Assurance Manager

I believe the best is yet to come.As a Gentiva employee, we give you everything you need to make the most of your career, including advanced education and training, the latest resources and the industrys highest standards of clinical excellence. When you work for Gentiva, you can expect more: more opportunities, more challenges, more rewards. Thats why Gentiva is the employer of choice for some of todays most experienced and talented employees.

*Gentiva Health Services, Inc. is an Affirmative Action/Equal Opportunity Employer M/F/D/V encouraged to apply.
Country: USA, State: South Carolina, City: Columbia, Company: Gentiva Health Services, Inc..