Quality Review Manager RN

Overview

Job Summary

The Quality Review Manager (RN) is responsible for ensuring that patient care is coordinated and managed appropriately.

• Receives case referrals. Reviews available patient information related to case, including disciplines required, to determine home care needs.
• Reviews each case by evaluating the services provided by clinicians, runs case, performs record review, instructs and guides clinicians to promote more effective performance and delivery of quality home care services and is always available during operating hours to assist clinicians as appropriate.
• Establishes patient’s clinical diagnosis according to referral documentation and coding guidelines, ensuring appropriate ICD-10 Coding and sequencing as it relates to the patient’s medical condition including any co-morbidities.
• Assists clinicians in establishing the POC including but not limited to medications review, ordered procedures/treatments, short and long-term therapeutic goals.
• Prospective review of OASIS assessments including Start of Care, Resumption of Care, Recertification, Transfers, and Discharge to ensure appropriateness, completeness, and compliance with state and federal regulations.
• Consults with the appropriate clinician to clarify any issues and/or corrections to documentation; documents same in the medical record.
• Tracks any trends or issues while reviewing OASIS documentation and alerts the DOE for additional training as needed.
• Attends case conference meetings with Organization personnel to facilitate coordination of care.
• Conducts quarterly record reviews and communicates findings and recommendations to appropriate Organization personnel.
• Assists in the orientation of new Organization personnel as requested.
• Assists Director of Education in the planning, implementation and evaluations of in-service and continuing education programs.
• Performs direct patient care duties as appropriate.
• Complies with accepted professional standards and principles.
• Promotes customer service to all Organization personnel.
• Stays informed about changes in the field of home health care.
• Performs other duties and activities as delegated by the Administrator/Branch Director/Branch Manager.
• Performs all other duties as assigned.

• Registered Nurse (RN) with current licensure to practice professional nursing in the State.
• Graduate of an accredited nursing school; BSN degree preferred.
• Two (2) years of prior home health care experience.
• One (1) year of management or supervisory experience in a health care setting, preferably home care.
• Complies with accepted professional standards and practice.
• Must be a licensed driver with an automobile that is insured in accordance with state requirements and is in good working order.
• Complies and maintains current CPR certification.
• Demonstrates excellent observation, verbal and written communication skills.
• Verbal and written communication skills in English.