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Manager of Clinical Practice & Quality Assurance
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 Manager of Clinical Practice & Quality Assurance a unique employment package that includes:
I believe that a stronger team begins with me.
As a Manager of Clinical Practice & Quality Assurance, you will:
- Review 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.
- Oversee the maintenance of clinical records and files to comply with Conditions of Participation (COPs), using measurements, as licensure, certification, and accreditation results.
- Audit charts for clinical oversight and compliance and adherence to the Medicare guidelines.
- Manage clinical activities, including patient assessments, care plan development, service level determination, on-site field visits, and the implementation/coordination/maintenance/evaluation of care plans.
- Responsibility for direct supervision of clinical staff. Participate in the recruitment, interviewing, selection, and orientation of team members; evaluate their performance relative to job goals/requirements; coach staff and recommend in-service education programs and ensure adherence to internal policies/standards. Manage the assignment of clinical associates.
- Ensure service quality and participate in care coordination to ensure proper communication between caregivers, patients, referral sources and payers. Discuss operational issues, update staff on new/changed regulations and reviews records/documentation to ensure regulatory and in-house compliance.
- Oversight of clinical integrity of appropriate documentation, quality of care provided, visits utilization, appropriate contacts with physicians, adherence to the care plan, and evidence of communication between disciplines.
- Accountable for financial responsibility related to budget goals through utilization, documentation, providing appropriate and accurate patient care, case mix weight, and appropriate utilization of delivery of patient care.
- Conduct and/or delegate the assessment and reassessment of patients, including updating of care plans and interpreting patient needs, while adhering to Company, physician, and/or health facility procedures/policies.
- Coordinate communication between team members/attending physicians/caregivers to ensure the appropriateness of care and outcome planning and ensures compliance through review of documentation and care coordination activities.
- Interpret standards/company policies/procedures to ensure compliance with external regulatory authorities and ensures that caregiver clinical documentation meets internal standards.
- Participate in performance improvement activities, maintain ongoing clinical knowledge through internal/external training programs, provide interpretation of knowledge and direction to staff.
- Identify clinical problem areas and document deficiency trends in a proactive approach. Educate administrative and clinical associate staff in the correction of these deficiencies.
- Assist with quality improvement and Medicare compliance training program.
- Communicate 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, monitor the receipt of Medicare denials, Billing Compliance held claims, and other payer denial notices. Assess the validity of these denials, and respond with additional information. Inform the Branch Director and Branch staff of noticeable trends or relevant issues.
- Collaborate with the Clinical Leadership and clinical associate staff in resolving complex clinical issues.
- Collaborate with branch Clinical Leadership to analyze Performance Improvement trends in the delivery of care. Carry 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.
- Facilitate initiating and gathering the competed CRR tools on a monthly basis and communicate to the Area Education or Area Clinical Specialist when task is completed.
- Serve as the Chairperson of the Quality Assurance Committee. Conduct the committee's quarterly meetings utilizing the Performance Improvement Recommended Timeline as a guide and coordinate and compile the data for the meetings.
- Review OASIS documents for accuracy and completeness prior to locking and submitting data electronically. Explain and mentor clinicians and staff on COP's and on billable skilled visits.
- Educate and mentor 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.
- Facilitate the ICD-9 coding of the Plan of Treatment based on OASIS data and patient assessment documentation that is assessed at the bedside.
- Collaborate 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.
- Ability to partner with sales team and participates in sales calls to provide clinical expertise as needed. Maintain relationships with referral/community sources.
- Current RN or PT active license
- Minimum of 3 years experience preferably in a homecare setting
- Minimum of 1 year supervisory/management experience
- Proven track record of clinical management, education and management of healthcare staff
- 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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