Quality Review Nurse

General Summary of Position
Reviews documentation, communicates with supervisors, and performs documentation audits.

Primary Duties and Responsibilities

• Contributes to the achievement of established goals and objectives and adheres to department policies, procedures, quality standards, and safety standards. Completes annual Code of Conduct, Compliance, and other mandatory training. Complies with governmental and accreditation regulations.
• Assesses documentation for compliance with agency standards, policies and procedures, governmental and accreditation regulations.
• Assists in determining if the order is required, appropriateness of order content, and that the name(s) of the correct physician(s) is assigned to the order for all 485s and verbal orders to assure timely completion and accuracy.
• Codes and sequences diagnoses including co-morbidity diagnoses pertinent to the home care episode.
• Completes corrections to OASIS verification reports and assessments for timely billing.
• Identifies clinician education needs. Develops and participates in education to all clinical staff related to documentation issues.
• Maintains effective relationships with other departments. Participates in multidisciplinary quality and service improvement team meetings and on committees as assigned. Enhances growth and development and enriches personal knowledge and skill through participation in educational programs and affiliations.
• Maintains ongoing communication with the Operations Director and supervisor to provide feedback, discuss new developments, and exchange information regarding staff problems with documentation compliance issues.
• Participates in process/performance improvement activities, and in updating the Quality Review process and tools as needed.
• Performs audits as assigned for appropriateness and completeness of care according to Plan of Care and regulatory requirements. Assists in preparation for and support of accreditation surveys. Conducts chart audits for performance improvement activities.
• Performs workflow tasks as assigned.
• Provides feedback and input related to policies and procedures to comply with new and existing regulatory standards.
• Provides a skilled review of clinical charts in utilization review/pre-post billing audits to ensure meeting agency policy/program and regulatory requirements. Includes written explanation when deficient areas identified. Assists in identifying appropriateness in billing and makes recommendations for improvement.
• Responds to urgent requests in a timely manner for all documentation and care needs.
• Reviews admission Assessments, ROC/recerts, transfers, and discharges for accuracy appropriate skilled care needs. Communicates with staff regarding deficient documentation. Utilizes reports to monitor and lock assessments timely.
• Reviews all OASIS discharges from all agencies for accuracy, as assigned.
• Participates in meetings and on committees and represents the department and hospital in community outreach efforts. Participates in multi-disciplinary quality and service improvement teams.

Minimum Qualifications
Education

• Bachelor's degree or an equivalent combination of education and experience required

Experience

• 3-4 years Home care nursing experience; quality assurance/utilization review experience preferred

Licenses and Certifications

• RN - Registered Nurse - State Licensure and/or Compact State Licensure Valid RN license in the District of Columbia, and the State of Maryland or Virginia required

Knowledge, Skills, and Abilities

• Extensive knowledge of Medicare and TJC guidelines, OASIS, and ICD-10 coding guidelines.
• Attention to detail.
• Basic computer skills preferred.

Why MedStar Health?
At MedStar Health, we understand that our ability to treat others well begins with how we treat each other. We work hard to foster an inclusive and positive environment where our associates feel valued, connected, and empowered. We live up to this promise through:

• Strong emphasis on teamwork - our associates feel connected to each other and our mission as an organization. In return, our effective team environment generates positive patient outcomes and high associate satisfaction ratings that exceed the national benchmark.
• Strategic focus on equity, inclusion, & diversity - we are committed to equity for all people and communities. We continue to build a diverse and inclusive workplace where people feel a sense of belonging and the ability to contribute to equitable care delivery and improved community health outcomes at all levels of the organization.
• Comprehensive total rewards package - including competitive pay, generous paid time off, great health and wellness benefits, retirement savings, education assistance, and so much more.
• More career opportunities closer to home - as the largest healthcare provider in the Baltimore-Washington, D.C. region, there are countless opportunities to grow your career and fulfill your aspirations.

About MedStar Health
MedStar Health is dedicated to providing the highest quality care for people in Maryland and the Washington, D.C., region, while advancing the practice of medicine through education, innovation, and research. Our team of 32,000 includes physicians, nurses, residents, fellows, and many other clinical and non-clinical associates working in a variety of settings across our health system, including 10 hospitals and more than 300 community-based locations, the largest home health provider in the region, and highly respected institutes dedicated to research and innovation. As the medical education and clinical partner of Georgetown University for more than 20 years, MedStar Health is dedicated not only to teaching the next generation of doctors, but also to the continuing education, professional development, and personal fulfillment of our whole team. Together, we use the best of our minds and the best of our hearts to serve our patients, those who care for them, and our communities. It’s how we treat people.

MedStar Health is an Equal Opportunity (EO) Employer and assures equal opportunity for all applicants and employees. We hire people to work in different locations, and we comply with the federal, state and local laws governing each of those locations. MedStar Health makes all decisions regarding employment, including for example, hiring, transfer, promotion, compensation, benefit eligibility, discipline, and discharge without regard to any protected status, including race, color, creed, religion, national origin, citizenship status, sex, age, disability, veteran status, marital status, sexual orientation, gender identity or expression, political affiliations, or any other characteristic protected by federal, state or local EO laws. If you receive an offer of employment, it is MedStar Health's policy to hire its employees on an at-will basis, which means you or MedStar Health may terminate this relationship at any time, for any reason.