Description
Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines.
Today at Penn Medicine, someone will make a breakthrough. Someone will heal a heart, deliver hopeful news, and give comfort and reassurance. Our employees shape our future each day. Are you living your life's work?
Summary:
- The Home Health Quality Specialist is responsible for collaborating with clinicians at established points in time to ensure accuratecompletion of assessments and development of effective plans of care to assure appropriate utilization and promote appropriate qualitypatient care and positive patient outcomes.
Responsibilities:
- Assure the accuracy of assessment documentation and development of the Plan of Care (485s) by reviewing all admissions forappropriateness, reviewing clinical assessments with clinical staff to determine patient needs, reviewing the reliability of functionalscore as needed, and review primary diagnosis codes for alignment with POC and reason from the Home Health episode.
- Reviewing and Analyzing OASIS data to ensure accuracy. Reviewing utilization orders and POC for alignment andappropriateness of care.
- Ensure patients meet home care admission requirements. Collaborate with clinicians to confirm assessment documentationand Plan of Care Support Home Health criteria. Review the accuracy of visit frequency according to orders and agencyguidelines.
- Ensure ongoing proper utilization of resources by reviewing all PDGM episodes (including resumptions and recerts), reviewing the decision support system reports and all related alerts, and advising staff regarding the need for SCIC assessments if there are changes in condition.
- Review and collaborate with a clinician(s) on any variation from the Oasis, POC, and authorized visits. Upon discussion withclinical staff, approve updates or changes.
- Collaborate with clinical staff, clinical supervisors, and managers to facilitate accurate and thorough care planning throughoutthe patient's episode of care
- Notify managers of discrepancies and inconsistencies.
- Serve as a resource to staff related to clinical assessment of patients and the need for appropriate interventions (therapy,nursing, HHA, and social work)
- Identify cases for interdisciplinary case conferences for the assigned team(s) and attend as indicated. Participate in re-certification conferencing as needed.
- Collaborate with clinical supervisors/managers in the education process for clinical staff by communicating staff performanceissues to the clinical manager.
- Participate in department and team meetings to provide education to staff on compliant documentation and regulatory updates.
- Perform joint home visits with staff requiring additional education and identify high-risk cases related to assuring OASIS andPOC documentation competency. Also, joint home visits should be provided to new employees.
- Proficient use of Home Care Information System and Decision Support software. Prepares, distributes, and presents reportsrelated to utilization of care and clinical outcomes as needed.
- Performs comprehensive chart audits as needed to identify performance improvement needs. Develop appropriate educationand monitoring to ensure clinical excellence and quality patient care objectives are achieved.
- Monitors key agency reports to manage the quality review process
Credentials:
- PT or RN (Required)
- Currently licensed as a professional Registered Nurse or Physical Therapist in the state of Pennsylvania.
- Basic Cardiac Life Support (Required)
- Driver's License (Required)
- Car Insurance (Required)
Education or Equivalent Experience:
- Bachelor of Science (Required)
- Education Specialization:
Nursing from an accredited school of nursing OR Bachelor’s Degree in Physical Therapy from an accredited school of Physical Therapy
Equivalent Experience:
•And 2+ years Experience working with Medicare Regulations for OASIS, compliance, and coding and/or experience in home care criteria and processes related to Managed Care.
We believe that the best care for our patients starts with the best care for our employees. Our employee benefits programs help our employees get healthy and stay healthy. We offer a comprehensive compensation and benefits program that includes one of the finest prepaid tuition assistance programs in the region. Penn Medicine employees are actively engaged and committed to our mission. Together we will continue to make medical advances that help people live longer, healthier lives.
Live Your Life's Work
We are an Equal Opportunity employer. Candidates are considered for employment without regard to race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran or any other status protected by applicable law.
