Clinical Specialist (Qapi)

Position Summary:
Assists the Clinical Director and Administrator with program goals, focusing on the organizational efforts to meet standards to maintain Medicare and State Licensure requirements, CHAP standards of excellence and Peoples Home Health policies and procedures. Provides overall QAPI tasks and utilization review by ongoing clinical record and Oasis reviews, as well as analysis of clinical outcome data and measurements. Assists with all quality improvement projects and completes QAPI quarterly and annual summary. Provides follow up recommendations for improvement opportunities and reports findings and recommendations to Clinical Operations team. Assists with PCR and VBP requirements to ensure improvement and compliance.
Essential Duties & Responsibilities:

• Abide by and demonstrate the company Mission, Vision, and Guiding Principles through both behavior and job performance on a day-to-day basis.
• Coordinate and maintain QAPI activities, assist clinical leadership with agency training manuals and reference materials.
• Assist with the maintenance of Medicare/State Licensure requirements to ensure the organization continues to meet standards.
• Maintain current knowledge of Peoples Home Health policies and procedures and regulations for State of Florida, Medicare Conditions of Participation and CHAP Standards to meet regulatory compliance.
• Assist with policy and procedure review and revision.
• Perform review of Clinical records and oasis data for services provided to ensure they are in accordance with Peoples Home Health policies and procedures, regulations for States of Florida and Medicare Conditions of Participation and CHAP Standards to meet regulatory compliance.
• Assist in maintaining audit tools and information for quarterly and annual QAPI requirements. Ensure information is collected, recorded, reviewed, and posted timely. Assist with QAPI and documentation education of new hires and existing staff related to QAPI goals.
• Perform initial and follow up evaluation of performance improvement tasks verifying recommendations for improvement have been completed. Includes Adverse Events/occurrence reports, infection control, patient satisfaction and other performance improvement initiatives as assigned.
• Maintain and complete chart reviews /clinical utilization reviews as outlined by the Performance Improvement Program on a monthly basis. Complete all QAPI program tasks on a monthly, quarterly, and annual basis.
• Ensure quarterly QAPI data is completed timely for presentation to Peoples Home Health leadership team and board members. Assist and complete ADR's, provide feedback to clinical team and assist in implementing action plans to meet regulatory requirements.
• Monitor clinical outcomes, process measures and STAR ratings; develop, implement, and maintain a PIP (Performance Improvement Plan) until improvements are noted. Promote a positive image of the Peoples Home Health concept throughout the office and community.
• Comply with all Peoples Home Health Policies, Procedures and Personnel Policies, including those specifically addressing disaster preparedness and response.
• Assist with education/reeducation of clinical staff by reviewing documentation requirements; reporting findings and doing additional follow up as needed.
• Assist with Oasis scrubbing, coding and PCR review as directed.
• Perform other duties as assigned by direct supervisor.

Skills:

• Self-Starter - Takes initiative identifies needs of co-workers and customers and solves problems.
• Reading Comprehension - Understanding written sentences and paragraphs in work related documents.
• Time Management - Able to prioritize and manage time effectively and make independent decisions when necessary.
• Speaking - Talking to others to convey information effectively.
• Writing - Communicating effectively in writing as appropriate for the needs of the audience.
• Critical Thinking - using logic and reasoning to identify the strengths ands weaknesses of alternative solutions, conclusions, or approaches to problems.
• Able to perform the essential functions of the job with or without accommodation.

Requirements
Licenses, Certifications and/or Registrations:

• Florida RN license from an accredited school of nursing is required.
• Bachelor of Science in Nursing is preferred.
• Oasis / Coding certifications.
• CPR certification

Education/Experience:

• A minimum of two (2) years of clinical nursing experience in home health.
• Proficiency in Microsoft Word and Excel is required.

Working Conditions:

• Office Environment. May be exposed to biological hazards.