Quality Assurance Manager
Quality Assurance Manager
I believe that better care begins at home.
Compassionate care, uncompromising service and clinical excellence - that's what Gentiva' patients have come to expect from our clinicians for nearly 40 years. Gentiva, America's homecare leader, has set the clinical standard for today's fastest-growing segment of healthcare - homecare. By creating innovative solutions that lead to high-quality patient outcomes, Gentiva's patient-centered approach improves quality of life and independence. With Gentiva, great healthcare has come home.
I believe I can make a difference.
With almost 40 years of experience and more than 380 locations in 39 states, Gentiva serves approximately half a million patients annually. Gentiva is a company on the move - driving some of the most exciting new opportunities in home healthcare. Financially and strategically, we are positioned to be a key player in the industry for years to come. All of which make Gentiva the place to be.
I believe in working for a company that cares as much as I do.
Gentiva offers our Quality Assurance Manager a unique employment package that includes:
I believe that a stronger team begins with me.
A Quality Assurance Manager will:
- Reviews all Medicare and other episodic payers' clinical records at the local level to assure appropriate documentation for reimbursement. This review includes verification of appropriate documentation, quality of care provided, visits utilization, appropriate contacts with physicians, adherence to the care plan, and evidence of communication between disciplines.
- Oversees the maintenance of clinical records and files to comply with Conditions of Participation (COPs), using measurements, as licensure, certification, and accreditation results.
- Audits charts for clinical oversight and compliance and adherence to the Medicare guidelines.
- Identifies clinical problem areas and documents deficiency trends in a proactive approach. Educates administrative and clinical associate staff in the correction of these deficiencies.
- Assists with quality improvement and Medicare compliance training program. Utilizes Gentiva Health Services approved reference materials to resolve inadequacies.
- Communicates with the Area Education Specialist regarding identified trends of deficiencies with Medicare Conditions of Participation, clinical care, coordination of care, and documentation for the purposes of requiring more extensive education or action of clinical staff.
- In accordance with the Branch director, monitors the receipt of Medicare denials, Tampa Billing Compliance held claims, and other payer denial notices. Assesses the validity of these denials, and responds with additional information. Informs the Branch Director and Branch staff of noticeable trends or relevant issues.
- In accordance with the Branch director, prepares and files general appeals on a timely basis. Attends fair hearings as necessary.
- Collaborates with the Clinical Leadership and clinical associate staff in resolving complex clinical issues.
- Participates in the initial orientation of the clinical associate staff regarding Medicare Conditions of Participation and relevant requirements for care and documentation and provides education during the orientation in the timeliness of paperwork and flow of Oasis.
- Collaborates with branch Clinical Leadership to analyze Performance Improvement trends in the delivery of care. Carries responsibility of keeping up with the performance indicators and monitoring of the Performance Improvement plan for the Branch. Essential in driving performance measures in the Branch.
- Facilitates initiating and gathering the competed CRR tools on a monthly basis and communicates to the Area Education or Area Clinical Specialist when task is completed.
- Serves as the Chairperson of the Quality Assurance Committee. Conducts the committee's quarterly meetings utilizing the Performance Improvement Recommended Timeline as a guide and coordinates and compiles the data for the meetings.
- Reviews OASIS documents for accuracy and completeness prior to locking and submitting data electronically. Explains and mentors clinicians and staff on COP's and on billable skilled visits.
- Educates and mentors clinicians one on one (in person or over the phone) regarding concerns, questions, accuracy of OASIS data, and other related documents, that are being reviewed.
- Facilitates the ICD-9 coding of the Plan of Treatment based on OASIS data and patient assessment documentation that is assessed at the bedside.
- Collaborates with Branch leadership to ensure effective and efficient episodic management, utilizing Gentiva Health Services reports such as Projected vs Actual, PPS Unbilled and Post Billing Adjustment, to identify trends.
- Bachelor's Degree in Nursing or the equivalent
- A minimum of three to five years nursing experience, including two years of home healthcare experience within the past five years.
- Prior ICD-9 coding experience is highly desirable.
- R.N. Licensure in the state(s) of practice.
- A working knowledge of Medicare home health requirements is essential.
- Outstanding leadership and managerial skills
- Good organizational, interpersonal and communication skills
I believe the best is yet to come.
As a Gentiva associate, we give you everything you need to make the most of your career, including advanced education and training, the latest resources and the industry's highest standards of clinical excellence. When you work for Gentiva Home Health, you can expect more: more opportunities, more challenges, more rewards. That's why Gentiva is the employer of choice for some of today's most experienced and talented associates.
*Gentiva Health Services, Inc. is an Affirmative Action/Equal Opportunity Employer M/F/D/V encouraged to apply.
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