Quality Review Specialist (Full-Time)

Responsible for the timely review of plan of care and OASIS time points in the electronic medical record to ensure accuracy of OASIS items, documentation, and utilization for quality and outcome management through clinician collaboration and implementation of best clinical practices. Responsible for identifying opportunities for improved OASIS accuracy and reporting these to OASIS clinical staff during scheduled staff meetings.

• Thoroughly reviews the medical record as part of the OASIS review process and recommend the most accurate codes, adhering to official OASIS guidelines as approved by the Centers of Medicare and Medicaid Services (CMS).
• Reviews plan of care; recommends edits to clinician and makes edits to the plan of care based on updated provider orders
• Consistently engages directly with clinicians to improve accuracy of OASIS assessments, ensure proper development of the plan of care relevant to the primary focus of care and the patient assessment, and assure clinically appropriate discharges.
• Assesses clinical documentation to ensure that it supports the recommended OASIS and POC changes.
• Consults the clinician for clarification, via electronic alerts, when conflicting or ambiguous documentation is present, and abides by the clinician's acceptance or declination of changes.
• In the event a clinician's declination will violate an OASIS guideline, follows the escalation process.
• Provides OASIS education to clinicians when opportunities arise (e.g., provide pertinent official OASIS guidelines or conventions when the clinician questions a change recommendation).
• Follows workflow/process exactly as outlined in training material without deviation.
• Meets or exceeds productivity expectations while maintaining excellent quality of reviews and the upmost customer service
• Participates in staff meetings and educational sessions.
• Maintains accurate and timely review of OASIS time points and all related interdisciplinary documentation via the workflow in the electronic medical record (EMR) for timely OASIS locks and submission to the Centers for Medicare and Medicaid (CMS). Participates in conferences or teleconferences with the Clinical Director, Patient Care Manager, and/or home health clinicians regarding identified OASIS, utilization, or plan of care inconsistencies.
• Utilizes available tools and develops training strategies to improve outcomes. Collaborates with Regional, Divisional, and Home Office support resources as needed for strategies.
• Develops and implements training based on evaluated competencies in documentation and clinical practice, edits from Strategic Healthcare Programs (SHP) alerts, and SHP reports for specific outcomes, adverse events, and utilization reports in conjunction with the OASIS Analyst, Clinical Director (CD), Executive Director (ED), or PI Coordinator.
• Consistently demonstrates sound judgment and professional communication in the day-to-day operations and interactions with co-workers and customers to facilitate coordination of care.
• Collaborates with regional PI coordinator & agency to facilitate initiatives to improve quality outcomes and agency ratings.
• Completes all required education timely.
• Adheres to established confidentiality standards as required by LHC and HIPAA concerning community and patient information.
• Identifies educational trends for agency and/or per clinician and discusses with Clinical Director and Quality Review Supervisor to further train/educate staff and improve OASIS accuracy. Reports to supervisor and operational leadership any continued lack of improvement or engagement from clinicians.
• QR Specialist may be required to relocate to a nearby office and perform PCM workflow occasionally.
• Performs other duties as assigned timely and effectively.

• Current CPR certification required
• Current Driver's License, vehicle insurance, and access to a dependable vehicle or public transportation
• 1 year Home Health experience as RN, PT, ST or OT
• Current RN. PT, ST, or OT licensure in state of practice
• Current COS-C or completion within 90 days of position effective date

Skill Requirements

• Ability to analyze OASIS data at a high level, and to accurately interpret and apply current OASIS guidelines, Conditions of Participation, and PPS guidelines to find opportunities for training and development.
• Effective verbal and written communication skills
• Strong computer skills with proven ability to use MS Office applications, OASIS review software, and clinical documentation software as well as reports available in these programs.
• Exceptional organizational skills