About

• Description
• Clinical Quality Reviewer
• General Summary: The Clinical Quality Reviewer is responsible for analyzing data integrity and consistency of OASIS documentation at the Start of Care, Resumption of Care, Recertification, and Discharge time points. This position will ensure appropriate ICD-10 coding and sequencing related to the patient's medical condition, including any co-morbidities related to the home health plan of care. The Clinical Quality Reviewer will identify if the physician-ordered home health plan of care incorporates best practices and provides patient-specific orders and goals. This Clinical Quality Reviewer will educate staff on OASIS accuracy and communicate with the Director of OASIS, Coding and Clinical Education, Clinical Managers, and office administration to maintain timely billing of RAPs.

Essential Functions

• Participate in the development of field clinicians that routinely perform OASIS assessments and of newly hired clinicians that will be responsible for OASIS assessments.
• Coordinate with assigned offices to review OASIS/Plans of Care as they are completed and coded by Corridor.
• Review assessments and visits based on items that are in the queue in Wellsky.
• OASIS and contents of POCs will be reviewed in detail for OASIS accuracy; identified OASIS corrections are to be documented and returned to the clinician for review and concurrence.
• Focus on best practice OASIS items and ensure documentation is present to support OASIS responses.
• Review to ensure appropriate utilization of resources to meet patient needs.
• Ensure that the frequency listed for each discipline is scheduled as ordered and that procedures are scheduled as referenced on the POC.
• Ensures appropriate ICD-10 coding and sequencing has been coded as it relates to the patient's primary diagnosis and co-morbidities.
• Review diagnoses for accuracy based on physician documentation and patient history and ensure that coding conventions are followed.
• Correct diagnoses code list where applicable on OASIS and keep records of trends with coding or review issues.
• Ensure that all diagnoses listed on the OASIS are reflected on the POC.
• Perform End of Episode Audits and Clinical Record Reviews as needed. This description is a general statement of required essential functions performed regularly and continuously. It does not exclude other duties as assigned.
• This description is a general statement of required essential functions performed regularly and continuously. It does not exclude other duties as assigned.
• Requirements

Experience

• Two (2) years of experience in the field of home health nursing
• Two (2) years of experience in coding and OASIS review
• OASIS and ICD coding certified. If not certified upon hire, arrangements are to be made for certification within the first six (6) months of employment in this position

Skills

• Possess knowledge of Medicare and Medicaid guidelines essential to Home Health Coverage
• Possess good organizational and time management skills
• Possess good problem-solving skills
• Possess strong verbal/written communication and interpersonal skills
• Aptitude for thoroughness and accuracy
• Initiative and the ability to work independently
• Flexible, dependable, and self-directed
• Computer, internet access, and email capabilities from home or other off-site location

Education

• Associate degree in nursing; baccalaureate degree in nursing.

Licensure/Certification

• Current driver's license in good standing. The employee is responsible for renewing their driver's license before it expires to continue employment.
• Reliable transportation and auto liability insurance.
• Current and unencumbered professional license as an RN in any/all applicable states.

Physical Requirements

• Prolonged sitting required in an office environment
• Ability to handle stressful situations in a calm and courteous manner at all times.
• Requires working under some stressful conditions to meet deadlines and Agency needs.

Environmental/Working Conditions

• Work is performed in a home office environment
• Work requires considerable sitting and close-up vision work
• Continually communicates with staff and other health care professionals utilizing email and telephone systems
• Must be able to articulate in a professional manner
• Typical weight lifted is five pounds; maximum weight lifted is ten pounds