Quality Review Coordinator (RN, Oasis, Utilization) - HomeCare

Company: Hartford HealthCare
Location: Bristol
Posted on: September 17, 2023

Job Description:

Description Job Schedule: Full Time Standard Hours: 40 Job Shift: Shift 1 Shift Details: Work where every moment matters.

Every day, over 30,000 Hartford HealthCare colleagues come to work with one thing in common: Pride in what we do, knowing every moment matters here. We invite you to become part of Connecticut's most comprehensive healthcare network as a Quality Review Coordinator. Hartford HealthCare at Home, the largest provider of homecare services in Connecticut, has been fulfilling our mission for more than 115 years. Our Person-Centered Care Model allows our employees to learn and grow within our organization, all while providing integrated support to the patient. As part of Hartford HealthCare, we leverage cutting edge technology to provide quality care in our client's home. Most importantly, our employees are appreciated for the real differences they make in both the lives of their clients and their clients' families. Job Summary:
Participates in improving the overall integrity of clinical documentation. Reviews clinical data upon admission, recertification, transfer, resumption of care and discharge for documentation consistency with Plan of Care, acuity level, service appropriation and completeness. Responsible for accurate, timely, and proficient completion of clinical and reimbursement documentation. Utilizes software applications as a tool to screen documentation accuracy. Independently makes corrections, where appropriate, in collaboration with the clinical case manager per agency policy. Responsible for the assignment of appropriate diagnosis code(s), as well as assuring accuracy. Provides direction to the clinical staff as it relates to clinical documentation. Collects and summarizes data related to inconsistencies and designs, develops, and implements interventions and supporting reference materials/modules to address. Supports Agency preparedness for oversight/accreditation review.

Responsibilities:
--- Performs qualitative, concurrent review of clinical documentation upon admission, recertification, transfer, resumption of care, and discharge documentation and associated physician orders and additional routine audits as directed by the Manager.
--- Reviews all clinical documentation, with a focus on data accuracy and consistency. Upon discussion/collaboration with clinicians, amends documents as needed to assure consistency and accuracy of information.
--- Assesses the overall Plan of Care (if indicated, includes Home Health Aide Plan of Care) to determine consistency with clinical documentation. Ensures consistency of HHRG assignment with the documented Plan of Care, as well as service appropriation.
--- Apply coding principles accurately, and in accordance with documented patient acuity levels.
--- Reviews medication profiles and physician orders (signing as indicated) assuring accuracy and completeness.
--- Provides recommendations to the clinical staff as it relates to accurate and timely clinical documentation.
--- Identifies and communicates significant documentation or clinical concerns to department manager, or designee. As directed by the Manager, collects data from routine audits like quarterly record and adverse event reviews, as well as targeted audits identified. Summarizes and analyzes data and develops reports as needed.
--- Collects and summarizes data related to documentation inconsistencies.
--- Problem solves and coordinates feedback regarding documentation inconsistencies with field staff and Clinical Managers, as indicated. Is able to connect feedback with regulatory requirements. Interface may take the form of multidisciplinary case conference, telephonic discussion, or one-on-one interaction.
--- Participates in training/instruction from formulated modules to affect and stabilize inconsistencies identified through the collection, analysis, and trending of concurrent review data.
--- Partners with Performance Improvement and Education Departments to set priorities and to design and implement educational activities for clinical staff.
--- Applies performance improvement methodology to evaluate the efficacy of designed interventions. Tracks the impact of improvement plans in targeted areas over time, communicating frequently with clinical staff.
--- Collects and summarizes data related to documentation inconsistencies and untimely processing. Produces reports, as appropriate and requested, to illustrate findings with recommendations for improvement.Qualifications Education & Training: Graduate of a National League of nursing accredited program or state approved Practical Nurse education program.

License/Certification: Current Connecticut RN or LPN license or eligible for RN or LPN License in the State of Connecticut.

Experience: Three (3) years of clinical nursing experience, at least one (1) year of which is in Home Health Care.

Skills:
--- Demonstrated excellence in nursing practice.
--- Well-developed interpersonal skills, self-motivated, creative, and good written and oral communication skills.
--- Ability to deal effectively with stress and multiple competing priorities.
--- Exhibits leadership and ability to work with clinical staff.
--- Knowledge of OASIS assessment and coding preferred.
--- Knowledge of licensure, regulatory and governmental requirements, CHAP accreditation standards, Agency policies, practices and protocols and other third party rules.
--- Computer proficient with knowledge of basic office technology.

Other: Valid motor vehicle operator's license, reliable personal automobile during business hours, and active automobile insurance coverage in accordance with Agency policy. We take great care of careers. With locations around the state, Hartford HealthCare offers exciting opportunities for career development and growth. Here, you are part of an organization on the cutting edge - helping to bring new technologies, breakthrough treatments and community education to countless men, women and children. We know that a thriving organization starts with thriving employees we provide a competitive benefits program designed to ensure work/life balance. Every moment matters. And this is your moment.

Keywords: Hartford HealthCare, Bristol , Quality Review Coordinator (RN, Oasis, Utilization) - HomeCare, Healthcare , Bristol, Connecticut