LPN Medical Review Assistant

TITLE: Medical/Clinical Review Assistant

REPORTS TO: Medical/Clinical Review Director

MINIMUM QUALIFICATIONS

1. Is a licensed practical nurse with current licensure to practice professional nursing in the state.

2. Is a graduate of NLN accredited school of nursing.

3. Prefer 1 year of nursing practice in the health care setting, preferably home care.

4. Complies with accepted professional standards and practice.

5. Possesses and maintains good physical stamina and mental health. Has presented a pre- employment health clearance.

6. Must be a licensed driver with an automobile that is insured in accordance with state and/or Agency requirements and is in good working order.

7. Is flexible and cooperative in fulfilling all obligations.

8. Has satisfactory references from current employers and/or professional peers.

9. Has excellent observation/communication skills and has good organizational skills.

10. Is self-directed with the ability to work with little supervision.

11. Is flexible and cooperation in fulfilling all obligations.

SUMMARY OF JOB RESPONSIBILITIES

The Medical/Clinical Review Assistant is responsible for coordinating medical and clinical data/documentation in a professional and timely manner. The Medical/Clinical Review Assistant will assist with ensuring that medical/clinical care and documentation, delivered by the staff, meet the patient/client needs, agency policies, State & Federal regulations, and educate staff as necessary. The Medical/Clinical Review Assistant will assist with reviewing and prepare clinical records as requested for medical review or by attorney, etc. in a timely manner. The Medical/Clinical Review Assistant will submit all data collected to the Medical/Clinical Review Director for final approval and submit records to the appropriate entities as directed.

RESPONSIBILITIES AND DUTIES

1. Reviews patient/client information (OASIS, Diagnoses, Frequencies, Disciplines, Supplies, etc.) to ensure appropriate home care services are being carried out.

2. Reviews medical records for appropriate preventative, therapeutic and rehabilitative procedures and techniques pertinent to patient/client care.

3. Reviews medical records for accurate and relevant clinical notes regarding patient’s/client's condition and care given, including physician notification and appropriate follow up.

4. Reviews clinical records, as necessary, for communication with physicians, nurses, social workers, discharge planners and other disciplines to establish a coordinated plan of home care.

5. Reviews medical records to ensure care is carried out as directed by the physician and patient's/client's medical diagnosis, medications, procedures and plan of care are appropriate to patient needs

6 Ensures proper maintenance of clinical records according to agency policies and procedures, and in compliance with local, state and federal laws.

7. Reviews clinical records requested for medical review, attorney request, etc.

8. Reports review findings on all chart reviews to the Medical/Clinical Review Director for final approval and submits records to the proper entities as directed.

9. Participates in public relation and community activities that promote the Agency's role as an effective member of the health care delivery system.

10. Demonstrates understanding of the Agency's mission, vision, philosophy and standards of care, through behaviors, which supports this.

11. Is available to staff members/disciplines as needed.

12. Performs duties within the limits of preparation and experience.

13. Uses supplies and equipment effectively and efficiently.

Other aspects and demands of the job not listed above:

The above statements are intended to be a representative summary of the major duties and responsibilities performed by incumbents of this job. The incumbents may be requested to perform job-related tasks other than those stated in this description.

WORKING CONDITIONS

1. General office.

2. Community home environment.

3. This position has been designated Class I. Employees performing Class I duties may be involved in potential exposure to bloodborne pathogens. All Class I employees will be offered Hepatitis B vaccination at no expense to the employee.

4. Exposure to infectious diseases.

5. In and out of automobile.

PHYSICAL REQUIREMENTS

1. Visual/hearing ability sufficient to comprehend written/verbal communication.

2. Ability to sit for long periods utilizing computer.

3. Ability to perform tasks involving physical activity, which may include heavy lifting and extensive bending and standing.

3. Ability to deal effectively with stress.

CONTINUING EDUCATION REQUIREMENTS

Agency personnel are expected to participate in appropriate continuing education as may be requested and/or required by their immediate supervisor. In addition, agency personnel are expected to accept personal responsibility for other educational activities to enhance job related skills and abilities. All agency personnel must attend mandatory educational programs.

I have read, and fully understand all information in the above job description. I meet the stated job qualifications, and am mentally and physically able to perform the responsibilities and duties of the above job description.