Employment Type:Full time
Shift:Day Shift
Description:RN Specialist - Performance ImprovementRN Specialist - Performance ImprovementPosition SummaryThe RN Specialist - Performance Improvement is responsible for supporting the agency's quality, compliance, and performance improvement initiatives through comprehensive clinical record review, OASIS oversight, utilization review activities, and documentation audits. This role ensures compliance with agency policies, regulatory requirements, accreditation standards, and payer guidelines while promoting accurate clinical documentation and quality patient outcomes.
The RN Specialist reviews OASIS assessments at Start of Care (SOC), Transfer, Resumption of Care, and Discharge to ensure accuracy and compliance with regulatory guidance. The position also participates in responses to payer denials, supports staff education on documentation standards and OASIS accuracy, monitors quality indicators, and collaborates with leadership to identify trends and implement performance improvement strategies.
Key ResponsibilitiesClinical Documentation & Quality Review- Review Plans of Care to ensure compliance with agency requirements and communicate necessary corrections to clinicians and supervisors.
- Conduct multidisciplinary patient chart audits, including comprehensive and focused reviews, and follow through on corrective action plans.
- Review OASIS assessments to ensure accuracy, regulatory compliance, and appropriate reporting of patient outcomes and process measures.
- Evaluate documentation for compliance with Medicare, Medicaid, agency, and accreditation requirements.
- Monitor Potentially Avoidable Events (PAEs) and identify opportunities for clinical and operational improvement.
- Participate in utilization review activities and support payer denial management by reviewing documentation and assisting with appeals and additional information requests.
Education & Consultation- Provide constructive and actionable feedback to clinicians regarding audit findings and documentation improvement opportunities.
- Assist in educating staff on documentation standards, compliance requirements, and OASIS accuracy.
- Present quality and compliance-related education at team meetings, skills days, and other staff development programs.
- Serve as a resource to clinical staff regarding documentation requirements, regulatory standards, and best practices.
Performance Improvement & Data Analysis- Maintain audit tracking logs and quality monitoring databases.
- Analyze audit findings and quality data to identify trends, risks, and opportunities for improvement.
- Utilize quality reporting tools, including SHP and EPIC reports, to identify high-risk and complex patient populations for review.
- Assist in the development, implementation, and revision of chart audit tools and quality monitoring processes.
- Support Quality Assessment and Performance Improvement (QAPI) initiatives and reporting activities.
- Prepare quality reports and presentations for QAPI, Professional Advisory Committee (PAC), and leadership meetings.
Collaboration & Compliance- Collaborate with supervisors, directors, and clinical leadership to promote documentation consistency and quality outcomes.
- Provide recommendations regarding policies and procedures based on audit findings and regulatory changes.
- Report significant compliance concerns and serious findings to appropriate leadership immediately.
- Participate in agency committees, workgroups, and organizational performance improvement initiatives.
- Maintain current knowledge of federal and state regulations, OASIS guidance, accreditation standards, and agency policies.
- Support the organization's compliance program and complete all required mandatory education and training.
Additional Responsibilities- Foster collaborative working relationships across departments.
- Represent the agency professionally through positive interactions with staff, leadership, patients, and stakeholders.
- Maintain ongoing professional competency through continuing education and professional development activities.
- Perform other duties as assigned.
Minimum QualificationsEducation- Associate Degree in Nursing required.
- Bachelor of Science in Nursing (BSN) preferred.
Licensure & Certifications- Current Registered Nurse (RN) license in New York State.
- Current CPR certification required.
- Valid driver's license required.
Experience- Minimum of 3-5 years of community health nursing experience in a home care setting.
- Experience with OASIS assessment review and home health documentation preferred.
- Experience in quality improvement, chart auditing, utilization review, or regulatory compliance preferred.
Knowledge, Skills, and Abilities- Thorough knowledge of current nursing standards of practice and the New York State Nurse Practice Act.
- Strong understanding of Certified Home Health Agency (CHHA) and Licensed Home Care Services Agency (LHCSA) operations.
- Knowledge of Medicare and Medicaid reimbursement requirements.
- Familiarity with CHAP accreditation standards and regulatory compliance requirements.
- Advanced knowledge of OASIS guidance and home health quality measures.
- Strong analytical and critical thinking skills.
- Ability to identify trends, risks, and opportunities through data analysis.
- Effective verbal and written communication skills with the ability to provide constructive feedback.
- Strong organizational skills and attention to detail.
- Proficiency with electronic medical records and quality reporting systems, including EPIC and SHP.
- Ability to work independently while collaborating effectively with interdisciplinary teams.
Preferred Qualifications- BSN or higher degree in Nursing.
- OASIS certification or advanced home health quality credentials.
- Previous experience in Performance Improvement, Quality Assurance, Clinical Documentation Integrity, Compliance, or Utilization Review.
- Experience preparing QAPI reports and leading performance improvement initiatives.
Work EnvironmentThis position functions primarily in a professional office and healthcare environment and requires frequent review of electronic health records, quality reporting systems, and regulatory documentation while collaborating with clinical and operational leadership to improve agency performance and patient outcomes.
Pay Range $39.45-$55.20Pay is based on experience, skills, and education. Exempt positions under the Fair Labor Standards Act (FLSA) will be paid within the base salary equivalent of the stated hourly rates. The pay range may also vary within the stated range based on location.
