Description: Implements, directs and monitors a comprehensive quality management program to encompass the performance of the clinical staff and support services for assigned home care agencies. Works with the Regional leadership team to ensure that the Regional Quality Improvement Plan is implemented and effectively measured and assessed and continuously improves the quality of care and service provided.
- Participates in the development of the Regional Quality Improvement Plan.
- Directs and monitors the implementation of the Quality Improvement Plan.
- Compiles reports and analysis of quality measures and customer satisfaction and works with the Quality
- Coordinators to address individual home care agency quality performance.
- Oversees utilization review and patient medical record audits according to agency's policies.
- Prepares and/or coordinates statistical reports on assigned agencies' results of utilization reviews, patient medical record audits and Medicare claim denials.
- Directs and monitors the implementation of corrective action plan for deficiencies identified through utilization review, clinical record audit, Medicare claim denials, client satisfaction surveys, JCAHO and/or State surveys.
- Stays current on and ensures compliance with regulations for certification, licensure, standards for JCAHO, and eligibility requirement under Medicare.
- Manages the Quality Coordinators to ensure that appropriate clinical documentation is present on progress notes and Medicare forms and that physician's orders are signed and placed in the patient medical records in a timely manner.
- Ensures that active and discharged clinical records are maintained to meet Federal and state regulations and standards.
- Develops, implements, and evaluates a process for review and response to additional documentation requests.
- Develops, implements, and evaluates a process for review and resubmission of denied Medicare claims.
- Develops, directs and evaluates the staff orientation program.
- Plans, implements, and evaluates in-service educational programs.
- Identifies the need for, plans and participates in providing special classes, conferences, and meetings to improve level of staff performance and quality of care.
- Communicates information concerning relevant educational offerings in the community.
- Policy and Procedure:
- Participates in the development and implementation of standardized policies and operating procedures to be utilized within the agency.
- Participates in the development of critical pathways and clinical data to be utilized for standardized outcome management.
- Minimum four (4) years of experience in home health care, with proven knowledge of TJC standards, certification, and reimbursement regulations.
- Baccalaureate degree is required.
Licenses, Certifications, Registrations
- License and current registration to practice as a registered professional nurse in California.
- In-depth understanding of Medicare Conditions of Participation, documentation and quality improvement.
- Leadership, mentoring and motivational skills.
- Strong interpersonal skills.
- Ability to communicate effectively in writing and verbally with people who have varied backgrounds.
- Strong organizational, planning, problem solving, decision-making, and leadership skills.
- Computer skills and ability to use word processing, data base, spreadsheet, etc. Applications.
- Must be able to work in a Labor/Management Partnership environment.
Job Number: 656616