Current COS-C or completion within 90 days of position effective date.PT, ST, or OT licensure in state of practice 1 year Home Health experience as RN, PT, ST or OT.Current Driver's License, vehicle insurance, and access to a dependable vehicle or public transportation.Performs other duties as assigned timely and effectively.QR specialist will continue to participate in on-call rotation for their originating agency if they were in the on-call rotation prior to QR role.QR Specialist may be required to relocate to a nearby office and perform PCM workflow occasionally.Reports to supervisor and operational leadership any continued lack of improvement or engagement from clinicians. Identifies educational trends for agency and/or per clinician and discusses with Clinical Director and Quality Review Supervisor to further train/educate staff and improve OASIS accuracy.Adheres to established confidentiality standards as required by LHC and HIPAA concerning community and patient information.Completes all required education timely.Collaborates with regional PI coordinator & agency to facilitate initiatives to improve quality outcomes and agency ratings.Consistently demonstrates sound judgment and professional communication in the day-to-day operations and interactions with co-workers and customers to facilitate coordination of care.Develops and implements training based on evaluated competencies in documentation and clinical practice, edits from Strategic Healthcare Programs (SHP) alerts, and SHP reports for specific outcomes, adverse events, and utilization reports in conjunction with the OASIS Analyst, Clinical Director (CD), Executive Director (ED), or PI Coordinator.Collaborates with Regional, Divisional, and Home Office support resources as needed for strategies. Utilizes available tools and develops training strategies to improve outcomes.Participates in conferences or teleconferences with the Clinical Director, Patient Care Manager, and/or home health clinicians regarding identified OASIS, utilization, or plan of care inconsistencies. Maintains accurate and timely review of OASIS time points and all related interdisciplinary documentation via the workflow in the electronic medical record (EMR) for timely OASIS locks and submission to the Centers for Medicare and Medicaid (CMS).Participates in staff meetings and educational sessions.Meets or exceeds productivity expectations while maintaining excellent quality of reviews and the upmost customer service.Follows workflow/process exactly as outlined in training material without deviation.Provides OASIS education to clinicians when opportunities arise (e.g., provide pertinent official OASIS guidelines or conventions when the clinician questions a change recommendation).In the event a clinician’s declination will violate an OASIS guideline, follows the escalation process.Consults the clinician for clarification, via electronic alerts, when conflicting or ambiguous documentation is present, and abides by the clinician's acceptance or declination of changes.Assesses clinical documentation to ensure that it supports the recommended OASIS and POC changes.Consistently engages directly with clinicians to improve accuracy of OASIS assessments, ensure proper development of the plan of care relevant to the primary focus of care and the patient assessment, and assure clinically appropriate discharges.Reviews plan of care recommends edits to clinician and makes edits to the plan of care based on updated provider orders.Thoroughly reviews the medical record as part of the OASIS review process and recommend the most accurate codes, adhering to official OASIS guidelines as approved by the Centers of Medicare and Medicaid Services (CMS).Responsible for identifying opportunities for improved OASIS accuracy and reporting these to OASIS clinical staff during scheduled staff meetings. Responsible for the timely review of plan of care and OASIS time points in the electronic medical record to ensure accuracy of OASIS items, documentation, and utilization for quality and outcome management through clinician collaboration and implementation of best clinical practices.
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