RN Quality Reviewer - Home & Community Care

Job Description

Description

PeaceHealth is seeking a RN Quality Reviewer - Home & Community Care for a Full Time, Day position.

This is a fully remote position the successful applicant will live in Oregon, Washington or Alaska.

In addition to a competitive hourly wage and excellent benefits, PeaceHealth is offering a $5000.00 sign on bonus to fill this position quickly. 

Must be fully vaccinated for COVID-19 including 2 doses of a 2-dose series or 1 dose of a 1-dose series plus 14 days beyond the final dose prior to start date.

JOB SUMMARY

Responsible for the quality review of all  HIS admission documents and Plan of Care to ensure CMS program compliance is met. Works closely with the System Manager of Quality for Home & Community along with Home & Community leadership to promote regulatory compliance and excellent patient outcomes and reimbursement. Serves as a consultant, auditor and HIS expert to Home Health staff across the PeaceHealth system.

ESSENTIAL FUNCTIONS

1.Ensures the timely review and processing of Hospice HIS admission document and Plan of Care.

2.Serves as stakeholder in determining appropriate HIS scoring for correct reimbursement.

3.Collaborates with leadership to audit and analyze performance trends in HIS accuracy; assist in determining learning needs for clinical staff.

4.Educates and provides feedback to clinical staff to correct completion on HIS admissions document.

5.Ensures the review of HIS data items and ensures HIS based process measures and HIS based outcome measures to positively impact Home Health Five Star score and Hospice Quality ratings.

6.Ensures regulatory compliance with HIS conventions and Plans of Care components.

7.Ensures timely processing of HIS to meet CMS guidelines and CMS billing requirements.

8.Promotes evidence-based practice care and documentation of skilled care.

9.Reviews all assigned HIS tasks on a daily basis.

10.Provides clinical and quality leadership and oversight for HIS reviews.

11.Performs other duties as assigned.

QUALIFICATIONS

EDUCATION:

• Must be a Registered Nurse in Alaska, Washington, or Oregon.

EXPERIENCE/TRAINING:

• Minimum 2 years’ nursing experience.
• Experience in Home Health or Hospice required.
• Experience with EPIC EMR system preferred

LICENSE/CERTIFICATION:

• HIS Certified Preferred for Home Health RN Quality Reviewers
• Must complete HIS Certification within 1 year of starting for Hospice RN Quality Reviewers.

OTHER SKILLS:

• Excellent verbal and written communication skills including sensitivity to other cultures and ethnicities.
• Strong analytical skills.
• Previous training experience and curriculum design a plus.
• Must possess excellent ability for conceptual thinking, good listening, problem resolution and planning skills.
• Must possess excellent organizational skills.
• Ability to work with basic office equipment.
• Ability to work well independently and in a remote environment.

REGIONAL/LOCATION SPECIFIC NOTES

• Travel may be required.

• Work requires fairly light physical exertion from up to 65% of the time.
• Ability to lift objects weighing 30 lbs. or less.
• Work is performed under normal working conditions with adequate lighting and ventilation.

See how PeaceHealth is committed to Inclusivity, Respect for Diversity and Cultural Humility.  

For full consideration of your skills and abilities, please attach a current resume with your application. EEO Affirmative Action Employer/Vets/Disabled in accordance with applicable local, state, or federal laws.