Nurse Consultant, Utilization Management
CVS Health
Quality Care Manager – Home Health, Registered Nurse
Mission Healthcare
full-time
Posted on:
Origin: • 🇺🇸 United States
Visit company websiteSalary
💰 $80,000 - $95,000 per year
Job Level
Junior
About the role
- Review patient assessments to ensure appropriate and effective care in compliance with agency policies, procedures, and regulatory requirements
- Communicate effectively with all members of the health care team and maintain collaborative relationships with leadership and other departments
- Perform review of documentation and plan of care to ensure congruency with primary focus of care, physician face-to-face encounter, homebound status, and appropriate disciplines
- Confirm all documentation submitted to workflow is accurate, complete, and sufficient to support skilled need and medical necessity
- Reinforce agency processes when offering feedback to clinicians regarding documentation deficiencies or OASIS corrections
- Ensure visit utilization is supported by individual patient assessment
- Review additional orders for appropriateness and confirm clinical documentation supports Recertification/Discharge decisions
- Approve the final Plan of Care (485) in a timely manner, confirming it is complete, accurate, and individualized to the patient’s needs
- Review all OASIS assessments for inconsistencies and lock timely
- Identify trends or patterns of inaccuracy and communicate to the Quality Director to assist in performance improvement and education planning
Requirements
- Must be a graduate of an accredited School of Nursing
- Current unencumbered license to practice as a Registered Nurse (RN)
- Minimum of 1 year of home health experience with a working knowledge of Title XX11, Medicare Home Health Conditions of Participation, and OASIS
- Excellent written and oral communication skills required
- Ability to handle stressful situations/deadlines
- Strong computer and software skills with knowledge of Home Care Home Base highly preferred
- Self-starter, goal directed with ability to work independently and stay focused without on-site supervision
- Ability to communicate effectively with agency staff, upper management, and other members of the health care team
