Quality Review Specialist

Title: Quality Review Specialist

Division: Senior Services

Status: Exempt

Reports to: Regional Director of Ops, Home Health

Revision date: January 2025

Supervises: n/a

PURPOSE

According to prescribed policies and procedures of the organization including all applicable state, federal and accreditation regulations and under the general supervision of the Regional Director of Ops, has the responsibility for driving and improving quality measures and outcomes within the assigned agencies.

ESSENTIAL FUNCTIONS

• OASIS & Documentation Audits: Perform thorough audits of OASIS assessments and clinical documentation submitted by field staff to ensure accuracy, compliance, and alignment with OASIS guidance and industry standards.
• Quality Improvement: Track, trend, and report on documentation audit results, identifying areas for improvement. Generate and analyze reports on quality measures, audit results, and compliance, presenting findings to leadership in a clear and actionable format. Develop and implement corrective action plans to address deficiencies and enhance the overall quality of care. Actively participate in the QAPI program.
• Regulatory Updates: Monitor changes in regulations and OASIS guidance, bringing these updates to the leadership team and field clinical staff. Provide education and training to prepare staff for regulatory changes, ensuring compliance with the ever-changing regulatory landscape.
• Staff Education: Provide ongoing education and training to field staff on proper documentation practices, OASIS completion, and coding guidelines to ensure adherence to regulatory and payer requirements.
• Collaboration with Leadership: Work closely with Directors of Clinical Management and other members of the leadership team to identify opportunities for quality improvement, share audit findings, and ensure consistency in care delivery.
• Technology Utilization: Use technology effectively, including Microsoft Office Suite, Clinical Comms, Outlook, SHP, and other technology tools, software and website resources. Proficiently navigate and utilize Home Care Home Base (HCHB) EMR & SHP to conduct audits, track trends, and monitor quality indicators.
• Backup Support: Provide backup support for the Coder and Director of Clinical Management, assisting with tasks and supporting the overall clinical management process when needed.
• Reimbursement Knowledge: Maintain expert knowledge of what drives reimbursement to proactively prepare the agency for changes in regulations and payer requirements, ensuring that the agency remains in compliance and is prepared for the future. (Example: VBP and the CMS 5 Star system).
• Attends and participates in regularly scheduled interdisciplinary team meetings to problem-solve, support and perform in-service education with staff.

EXPECTATIONS

• Demonstrates and maintains a positive, professional manner, manages time efficiently and effectively, provides leadership as a role model to promote a team approach, collaborates and participates in policy creation and appropriate problem solving methods.

• Must adhere to all policies, procedures, terms and conditions set forth in the National Church Residences' Employee Information Guide (EIG), the Code of Conduct, as well as any facility handbook, including but not limited to, corporate compliance, drug free workplace, safe work practices, all federal, state, local regulations and laws.

• With respect to Client Rights, ensures all care is provided with respect and dignity for the residents/clients, their families and the staff. Reports all complaints made by residents/clients and/or families to the appropriate supervisors, reports all allegations of abuse, misappropriation of funds/resident property and/or any other corporate compliance, drug free workplace, safe work practices, all federal, state and local regulations and laws.

• Completes all annual education requirements timely, including but not limited to Compliance, Privacy, Security and HIPAA training and exhibits behavior as set forth by the Code of Conduct in the performance of their duties.

• Performs other duties as assigned.

Education: High school diploma or GED required. Associates degree preferred.

OASIS and Coding certification required (i.e., COS-C, HCS-D, HCS-O or other relevant certifications).

Experience: Minimum of two years' experience in home care, a strong training background in assessments, clinical documentation and coding.

Travel: Minimal up to 10%

Mental: Must have excellent communication, comprehension, and interpersonal skills. Must have the ability to speak, read, write and understand English, as well as the ability to make self- understood.

Skills: Must have good working computer skills with basic professional computer software (Microsoft Office suite, Windows, etc.) and the capacity for learning new software systems quickly. Must be self-directed with excellent organizational skills and the ability to manage tasks and assignments concurrently. Must have strong motivational skills and a high emotional intelligence quotient (EQ)

Licensure: Must hold a valid license as a Physical Therapist or Registered Nurse in the state in which working.

Vision: Normal: Consistent with standard workflow.

With respect to said job description, estimate the daily time spent performing the following activities.

Rare (R) = 0-24%; Sometimes (S) = 25-49%; Frequent (F) = 50-74%; Continuous (C) = 75% plus

R = Climbing S = Stooping Lifting/Carrying: S = 10-25 lbs.

F= Standing R = Pushing S = 26-50 lbs.

F = Sitting R = Pulling R = 51-75 lbs.

S = Walking R = Driving R = 76 plus lbs.

Consequences of Errors: Some monetary responsibility.

Supervision Received: Moderate supervision: Employee generally operates by himself/herself checking with supervisor when in doubt and/or as scheduled.

Working Conditions: Good office working conditions.

ACKNOWLEDGEMENT

I hereby understand and agree to the above description of the duties required.

Signature Date

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, ancestry, military status, disability, genetic information and/or any other characteristics protected by applicable law.