Quality Review Specialist Part-Time Home Care

All the benefits and perks you need for you and your family:

• Commitment to whole-person care, giving you the opportunity to help heal people in mind body and spirit.
• Fulfilling work with people who treat you like family.
• Excellent benefits, market-driven wages and career development opportunities.
• Recognized for the seventh year in a row as a recipient of the Gallup Great Workplace Award as part of the AdventHealth network.
• Opportunities for advancement as we expand our network across the nation.

Our promise to you:

Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.

Schedule: Part-Time

Shift: 24 hours per week, 3 - 8hr shifts to be scheduled for Mon-Fri 8a-5p based on department needs.

Location: Virtual/Remote

The role you’ll contribute:

The Population Health Care Manager PT (PHCM) ensures effective utilization and case management oversight activities as defined by inter professional best practices, agency policies/processes. Ensures clear and appropriate visit utilization using evidence-based and best practice guidelines to achieve positive clinical outcomes and efficient use of resources. Identifies and collaborates with clinical supervisor on feedback and coaching opportunities of clinical colleagues. Works under supervision of Department Manager

The value you’ll bring to the team:

• Evaluates visits per episode for the optimal utilization that results in the best possible clinical outcomes and efficient use of resources.
• Analyzes utilization to ensure visits are made according to episode utilization guidelines and clinical outcomes best practices. Develops/revises utilization policies and practices based on analysis of past practices to improve utilization.
• Collaborates with colleagues, and field clinicians to achieve strategic aims, top decile outcomes and patient satisfaction.
• Mentors colleagues and encourages implementation of best practice guidelines
• Case Management:
• Determine patient risk for rehospitalization and appropriate care pathway
• Evaluate the need for virtual technology
• Develop plan of care (POC) and visit frequency and spacing
• Identify appropriate services to meet desired clinical and fiduciary outcomes and obtains physician orders if indicated
• Evaluates visits per episode for optimal utilization that results in the best clinical outcomes and efficient use of resources
• Daily completion of workflow to ensure timely patient care (Bypass stage 1, stage 2)
• Handles escalated clinical authorizations and denials, prioritizing timelines/limits Accountability / Fiduciary:
• Identifies quality performance improvement opportunities and leads/participates in these activities as needed/directed.
• Demonstrates effective, independent judgment in planning, performing activities that lead to consistent achievement of desired outcomes.
• Responsible for meeting/exceeding all established common goals and clinical outcomes.
• Utilizes clinical reports for relevant patient data and reviews patient's clinical condition in order to determine appropriate authorization.
• Reviews initial clinical documentation at identified timepoints (Admission, Add-on Eval, ROC, Recert and Discharge), for identified episodic payors, approves additional services.
• Align clinical pathways in accordance to standard work.
• Meets departments workflow and productivity standards. Compliance
• Understands, supports, articulates, and ensures faithful implementation of THAH policies and procedures.
• Assures compliance with payor and legal regulations and ensures accreditation readiness through record review, case conferencing and mentoring.
• Maintains knowledge of and reinforces applicable Federal, State and local laws and regulations, Trinity Organization Integrity Program, Business Code of Ethics, and policies/procedures to ensure honest, ethical, and professional standards of practice. People
• Provides support to staff.

• Provides just in time training/feedback to ensure compliance of regulatory documentation.
• Champions and improves client satisfaction through ensuring appropriate timely delivery of patient centered care
• Collaborates with population health colleagues, and Agency colleagues to achieve strategic aims, top decile outcomes and patient satisfaction
• Participates in special projects and performs other duties, as needed.
• Assist with identification of documentation deficiencies and opportunities for improvement.

Qualifications

The expertise and experiences you’ll need to succeed:

• Associate's degree in Nursing
• Registered Nurse license from the state in which practicing
• Home Care Experience required
• OASIS Experience & certification (COS-C) required
• Home Care Specialty Certification (HCS-D) required
• BSN degree strongly preferred

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances. The salary range reflects the anticipated base pay range for this position. Individual compensation is determined based on skills, experience and other relevant factors within this pay range. The minimums and maximums for each position may vary based on geographical location.

Category: Case Management

Organization: AdventHealth Home Care Central Florida

Schedule: Part-time

Shift: 1 - Day

Req ID: 24009324

We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.