The purpose of this position is to assess, monitor and advance clinical practices, particularly in the areas of compliance, documentation, PPS and OASIS, case management including utilization review, and critical thinking. This person works collaboratively with the QI Director and the Director of Patient Care Services providing information regarding OASIS competency and care coordination capabilities of the geographic team members.
Essential Job Functions:
- Establishes and monitors a team-based Compliance Program, focusing on issues such as fraud detection and prevention, adherence to federal and state regulations, and applicable clinical practice standards, and LMVNA policies and procedures.
- Performs OASIS competency testing for all geographic team clinicians who perform OASIS assessments.
- Reviews OASIS documentation and Plans of Care with assistance of other QI staff as needed and communicates with individual staff members regarding discrepancies and/or errors and tracks and trends individual staff performance for education and training purposes.
- Participates in patient case conferences for each team as scheduled.
- Works with clinicians and the clinical supervisors to make recommendations for care plan, nursing frequency and duration, and order of other disciplines.
- Exemplifies effective communication skills that includes communication with staff in a direct and effective manner, role models and facilitates interdisciplinary communication, addresses conflict at its source, seeks and adapts feedback and constructive criticism from staff, colleagues, patients, and referral sources. Communicates findings, issues and problems regarding compliance, documentation and clinical practice to the QI Director and the Director of Patient Care Services.
- Monitors quality of documentation for team of clinicians and for implementing strategies to improve clinical documentation; monitors medical record for timeliness completion.
- Identifies and monitors indicators of compliance, quality documentation, and clinical outcomes. Responsible for implementing strategies to improve clinical outcomes when indicated.
- Uses available data to track utilization and outcome information that is patient and staff specific.
- Provides input and participates in ongoing staff competency and evaluation of performance with the Director of Patient Care Services.
- Participates in team-based orientation of new staff. Educates new hires on how to do start of care visits.
- Exemplifies collaborative attitude and skill, including: demonstrates ability to function as a consultant, demonstrates and role models ability to negotiate integrity – preserving compromise, recognizes and respects perspective and expertise of others, respects others’ time and the constraints on it, demonstrates professional self-confidence.
- Promotes and facilities understanding of the fiscal impact of all clinical practices and documentation. Promotes cost effective clinical and documentation practices. Maintains knowledge of third party reimbursement requirements and regulation.
- Performs other duties as assigned and complies with all policies of LMVNA.
Education / Professional Requirements
- Valid California Registered Nurse License
- Valid Basic Life Support Certification
- Valid Driver License and auto insurance
- Minimum 2 years home care experience preferred
- Comprehensive knowledge of Medical Prospective Payment system and fraud issued in home care preferred
- Knowledge of computer, proficient with Microsoft Word and Excel.
- Good verbal and written communication skills.
- High level of attention to details.
- Able to work independently, take ownership and responsibility of tasks.
- Strong professional ethics, discretion and judgment.
- Good organizational skills.
