QA Registered Nurse

Overview The QA RN assists with day-to-day operational oversight of the Agency's skilled clinical programs, OASIS submission and review, documentation review, intake processes, pre/post billing, and DMAS paperwork review. Mentors staff on clinical software, client outcomes, performance improvement initiatives, and risk management programs. Promotes clinical standards in compliance with industry standards of care, regulatory compliance, and clinical competence. Oversees quality assurance functions to assure efficient high-quality documentation of services consistent with regulatory compliance, as well as Agency policies, procedures, standards, and financial objectives. Responsibilities Assesses and plans client care, as needed, using age-appropriate norms and principles of growth and development. Identifies client needs based on comprehensive assessment. Delivers care following physicians' orders, nursing standards, and Agency policies and procedures. Documents care according to regulatory requirements and Agency policies and procedures. Evaluates personnel performance and clinical documentation in accordance with organizational policies; counsels or corrects as needed; reports progress to Vice President of Clinical Services as appropriate. Teaches and assists clinical staff in appropriate case management and utilization of resources and regulatory compliance. Conducts educational presentations for clinical staff. Encourages clinical staff attendance at educational and work group meetings. Acts as role model and mentor for clinical staff. Submits and reviews OASIS information to ensure proper assessment and documentation by field staff. Reviews clinical staff documentation to ensure timeliness, accuracy, and completeness. Conducts pre- and post-billing reviews of Medicare, Medicaid, and Commercial skilled services. Knows and adheres to federal, state, and other regulatory agency requirements. Maintains strict confidentiality of patient, employee, and Agency information. Provides overall coordination and case management oversight of the Agency's clients; ensures clinical staff delivers high-quality services in an efficient and effective method. Utilizes Plans of Care (POCs), 485s, OASIS, orders, recertifications, transfers, and discharge planning to identify client needs and assures appropriate care is provided. Assists staff with ordering of medical supplies; monitors judicious use and allocation of needed supplies. When necessary, assists in appropriate triage of clients and planning for potential disasters. Collaborates with clinical staff to monitor client progress, POC revision, ancillary referral needs, and appropriate utilization of services. Conducts care conferences to assure interdisciplinary input to addressing client needs in order to obtain positive client outcomes, according to Agency standards. Assists with obtaining and processing referral information from multiple sources in an accurate and timely manner. Reviews referrals for thorough information; clarifies and pursues additional information as necessary to establish data to support the admission process. Participates with staff in discharge planning of clients. Review orders and release orders daily. Submission and review all OASIS and complete list to be submitted to state. Assists with developing and implementing appropriate process improvement plans that address issues related to Performance Improvement, Adverse Events, Case-mix, etc. Qualifications Has graduated from an accredited school of professional nursing; holds a valid Registered Nursing license in Pennsylvania. Prefer a Bachelor's degree in nursing or related field. Three years of nursing experience in home health field. Two years of supervisory experience preferred. Holds valid CPR certifications. Demonstrates clinical competency and provision of high-quality care to clients. Is knowledgeable of home health regulations. Exhibits outstanding organization, leadership, communication, and human relations skills. Is self-motivated, assertive, and able to make independent decisions. Employs critical thinking skills. Demonstrates ability to be flexible and to fulfill a broad range of clinical supervision responsibilities. Is able to handle multiple priority projects. Is able to use computer for word processing, spreadsheet, and data entry applications.

Created: 2024-11-02