Quality Reviewer

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Job Summary

The Quality Reviewer supports Home Care's compliance, clinical quality, and performance improvement functions by conducting chart audits, monitoring regulatory and payer compliance, and identifying trends to support agency-wide quality initiatives. Reviewer will complete Oasis documentation including: Start of Care, Re-certification, Resumption of Care, Follow up (SCIC), Transfer, Discharge OASIS, and Evaluation visits. Reviewer will identify documentation issues and provide education to staff as well as collaborate with leadership to promote patient centered care and enhance employee engagement in all roles.

Essential Functions

• C. Job Specific Contacts
  
  1. General Contacts: clinical staff, clerical staff , management
  
  2. Job Provides Direction to: clinical staff
  
  
  D. Environment and Demands
  
  1. Environmental Demands: Normal/busy office environment
  
  2. Essential Physical and Cognitive Demands, Manual Dexterity: Use of computers, telephone, office machines, fax machines, standard office equipment.
  
  
  B. MISSION/STRATEGIC PLAN:
  
  Participates in activities which support the mission of the hospital
  
  C. JOB SPECIFIC COMPETENCIES:
  
  *Demonstrates the required job specific technical professional knowledge, skills and abilities.
  
  1. Processes SOC/ROC/RECERT OASIS documentation and Patient Plan of Cares for elements to align with Oasis accuracy, consistency with the comprehensive assessment, appropriate interventions, and SMART goals aligning with COP, CMS and NYSDOH regulations in a timely manner.
  
  2. Completes accurate utilization review chart audits for multidisciplinary active and discharge cases to ensure appropriate patient care, service usage, as well as compliance with regulations, policies and processes.
  
  3. Reviews discharge and transfer oasis and summaries to ensure accurate capture of discharge/transfer status, reviewing oasis items, summary documentation and timely oasis submission.
  
  4. Provides education and follow-up with staff regarding opportunities for learning as it relates to findings of audits and documentation.
  
  5. Participates in special projects and performs other duties as assigned.
  
  * Document on addendum age specific competency.
  
  
  Part II: Employee Performance Standards
  
  A. CUSTOMER SERVICE:
  
  1. Demonstrates the ability to create a positive interaction with the customer.
  
  2. Demonstrates positive communication with people of different cultures, values & beliefs.
  
  3. Demonstrates the ability to acknowledge customer concerns and takes corrective action.
  
  4. Demonstrates compliance with identified customer service behaviors.
  
  5. Provides escort to customers when necessary.
  
  B. PERFORMANCE IMPROVEMENT:
  
  1. Participates in Department/Hospital-wide activities which improve processes and/or outcomes.
  
  2. Utilizes resources to maintain and improve self development and knowledge.
  
  3. Complies with licensure and/or certification requirements.
  
  4. Participates in annual competency assessment.
  
  
  C. BUDGET:
  
  1. Demonstrates fiscally prudent use of equipment and supplies.
  
  2. Utilizes charge process for supplies/equipment.
  
  
  D. PROJECTS/ASSIGNMENTS:
  
  1. Completes projects/assignments within projected time frames and expectations.
  
  2. Participates in committees and task forces as requested.
  
  3. Performs other duties as assigned within classification.
  
  4. Assists with the orientation process for new hires.
   

Qualifications

• BA Bachelor’s or Master’s required
• Minimum of three years clinical experience in home health care required, working knowledge of OASIS, PDGM, EVV systems, and Medicare/Medicaid home care regulations. Prior quality reviewer, utilization management or care management experience preferred. Proficiency in Microsoft Office applications required. Demonstration of analytical skills required.
• Excellent written communication for audit findings and staff feedback. Detail-oriented with ability to manage multiple concurrent chart reviews. Strong analytical skills; comfort with Excel and reporting tools.
• RN, PT, OT or related clinical license Required
• Oasis Certification Preferred