Clinical Review Manager
hace 3 días
Atlanta
Job Description Clinical Review Manager- Home Health – Remote (GA Only) Lead with compassion. Manage with purpose. Who are we? Caring for Atlanta for over 77 years, Visiting Nurse Health System is a leading, non-profit provider of home healthcare, long-term care at home, hospice, and palliative care services. We pride ourselves in helping patients and their loved ones receive care at home following an illness, surgery, or hospital stay. We offer not just a job, but we also offer purpose, impact, and the chance to care deeply for people in the comfort of their homes. Our vision is to be the first choice for patients, families, payers, and other healthcare providers when they need home healthcare services. We look to not only achieve, but to also maintain exemplary patient and employee satisfaction levels. VNHS is dedicated to continuing our investment in strong community partnerships, providing coordinated care solutions, developing a top-performing workforce, and innovating technologies to improve affordability and access to patient care. We aim to be an organization where healthcare professionals not only prefer to work, but where they are able to grow as professionals. For more information on our organization, please visit us here. Every day we strive to display our four core values: • Respect & Integrity - We practice the highest ethical standards and honor our commitments. We are fair, transparent, honest and person-centered in all our actions. We value the beliefs and opinions of our diverse community of patients and employees., • Excellence - We are committed to delivering the best outcomes and highest quality service through the dedicated efforts of every team member. We are committed to continuous improvement in all that we do and strive to be leaders for others to emulate., • Stewardship - We enhance the lives of those we serve through responsible planning and management of the resources entrusted to us with each of us contributing toward a shared purpose. The Clinical Review Manager will provide coding expertise to Agency(s) assigned for ICD-10 coding, reviewing OASIS, Plan of Care review/development, process & outcome measures, Star Rating items and all pertinent documentation to ensure accurate coding for each patient and ensures that all applicable Federal laws are followed. Applied knowledge of medical terminology, disease processes, and pharmacology required. This individual will be required to make independent decisions regarding accurate ICD10-CM code assignments, OASIS and Plan of Care (POC) recommendations under PDGM guidelines. The CR Manager will play a key role in determining the reimbursement potential of Family Home Health to which they are assigned and adherence to coding standards and regulations and corporate policies developed to ensure accurate billing. What You’ll Do: • Performs centralized coding for Home Health Agencies via scanned medical records and clinician documentation via EMR data., • Provides Home Health coding, OASIS, POC and quality review for assigned agencies. Able to make independent decisions regarding accurate ICD-10-CM coding and OASIS, POC and quality data assignments., • Reviews records, recommending changes for clinician review and acceptance, based on CMS regulation, industry standards, PDGM guidelines and coding convention as supported by documentation., • Reviews plan of care for accuracy and quality and make needed recommendations., • Applies knowledge of medical terminology, disease processes, and pharmacology., • Assess/review assessments for coding accuracy based on documentation, CMS regulations and coding conventions,, • OASIS compliance and Plan of Care quality and accuracy., • Maintain productivity number standards daily., • Codes all assessments using ICD-10 guidelines (SHP, and Decision Health Coding Pro software) as well as appropriate industry references., • Attend/participate in continuous learning and education in ICD-10 coding, OASIS, Quality and Plan of Care development as necessary. Keeps abreast of regulatory changes., • Should be good steward of all company financial resources, including but not limited to arrangements for equipment and other necessary items and services needed., • Performs duties in accordance of, and under the direction/supervision, as defined by the company organizational chart., • Assists on a variety of special projects and other duties as needed., • Completes and submits all documentation in a timely manner according to department policy., • Attends in-service and education as required., • Develops and delivers staff education on clinical practice, performance improvement, and regulatory requirements, serving as a subject matter expert on payer and compliance standards., • Conducts clinical record audits, analyzes and reports findings, ensures compliance and quality standards, and partners with leadership to improve documentation and drive home health quality initiatives., • Makes recommendations and findings available to the VP of Quality Compliance., • Prepares reports using analytical approaches, graphs, charts, etc. Schedule: • Full-time, • Flexible schedule with a combination of remote and in-field responsibilities, • Are a graduate of an accredited Baccalaureate RN program or equivalent, • Hold current RN Georgia licensure and CPR certification, • Proficiency in ICD coding and/ or OASIS Required, • Have 2 years of nursing experience in home health care, two years’ experience in quality improvement processes, experience in CMS, state and HH accreditation rules and regulations., • Must have demonstrated knowledge of the theories, principles, and practices of quality improvement as well as data analysis relative to performance improvement., • Can function independently in a community-based environment, • Possess strong clinical, documentation, and time management skills, • Are comfortable with EMR systems and standard office software & equipment, • Medical, Dental, and Vision insurance, • PTO and Paid Holidays, • 403b Retirement Plan with Company Match, • Flexible Spending Account (FSA), • Health Savings Account (HSA), • Life Insurance, • Employee Assistance Program, • Employee Discounts Join us in our mission to provide excellent care, comfort, and dignity to our patients! Visiting Nurse is an equal opportunity employer and does not discriminate against qualified applicants based on race, color, sex, gender, gender identity, gender expression, religious creed, sexual orientation, pregnancy, national origin, ancestry, age, military and veteran status, marital status, physical or mental disability, protected medical condition, genetic information, reproductive health decision-making, lawful off-duty use of marijuana, any other characteristic protected by law, or any combination of two or more of the characteristics listed here. If you need an accommodation to complete an online application, please contact Visiting Nurse at 404-215-6100.