Utilization and Quality Review Specialist- Home Care
: Job Details :

HOW WE CARE FOR YOU

At Rochester Regional Health, we are dedicated to getting health care right. Our robust benefits and total rewards foster employee wellbeing, professional development and personal growth. We care for your career while caring for the community.

• Health & Wellness Benefits starting Your First Day

• Medical, Dental & Vision Programs tailored to Your Needs

• Employee Assistance Program including free Mental Health

• Access to Life Coaches & Financial Counseling

• Retirement Savings Programs

• Employee Referral Program with Bonuses up to $10,000

• Student Loan Repayment Program

• Relocation Assistance

• Employee Discount Programs

• Free ASN to BSN Program through Advance U

SUMMARY

The Utilization and Quality Review Specialist is responsible coordinating/performing all activities related to the RRHS utilization review (UR) program and quality record documentation monitoring. A primary responsibility of this position (in addition to chart review for UR) is the timely review/approval of Start of Care Assessments including the Comprehensive Assessment, Physician Plan of Care, OASIS, and home health diagnosis coding. Reviews clinical documentation to ensure adherence to State and Federal regulations, payer requirements, and OASIS CMS guidance. Provides superior customer service by modeling the Brand Promise and the Core Values.

ROCHESTER REGIONAL HEALTH HOME CARE

When you or a loved one is recovering from an illness or injury, home health care can speed healing while also helping you maintain your independence. The Rochester Regional Health Home Care team has provided compassionate, personalized care and assistance for adults and children for more than 50 years, and our quality of care has been among the top-ranked home care groups in the nation.

STATUS: Full Time

LOCATION: Monroe County

DEPARTMENT: Home Care/Hospice- Quality Review

SCHEDULE: Monday-Friday, Day Shift

ATTRIBUTES

• RN Nursing Diploma required, ASN preferred

• 2-4 years of home care experience

• COS-C certification preferred

• Home Health Diagnosis Coding Certification preferred

• 1 year of home care quality/regulatory experience preferred

• 1 year of OASIS experience preferred

RESPONSIBILITIES

• Patient Care & Service. Performs co-visits or billable patient visits as needed, as requested by leadership. Responsible for ongoing documentation and chart audit: to include but not limited to home health diagnosis coding, OASIS Start of Care, Resumption of Care, Recertification, and Discharge chart audits, 485 audits, Plan of Corrections audits, compliance audits, etc.

• Planning. Participates in education of staff to include but not limited to quality initiatives, OASIS in-services, Policy and Procedures, Orientation.

• Communication. Collaborates with clinical practice and education nurse to ensure all quality and compliance activities are coordinated and based on data. Participates in educational opportunities provided to the team.

• Documentation. Responsible for the Quarterly Utilization and Review (U/R) process to include timely completion of required number of audits, documentation of audit results.

• Compliance. Develops new policies as assigned. Participates in the ongoing regulatory review, identifies and researches new regulations as assigned. Participates in the organizations policy and procedure review process as assigned. Responsible for maintaining current knowledge of home health diagnosis coding and OASIS review.

EDUCATION:

BS (Required)

LICENSES / CERTIFICATIONS:

BLS - Basic Life Support - American Heart Association (AHA), NYS DL - valid New York State Driver's License - New York State Department of Motor Vehicles (NYSDMV), RN - Registered Nurse - New York State Education Department (NYSED)

PHYSICAL REQUIREMENTS:

M - Medium Work - Exerting 20 to 50 pounds of force occasionally, and/or 10 to 25 pounds of force frequently, and/or greater than negligible up to 10 pounds of force constantly to move objects; Requires frequent walking, standing or squatting.

For disease specific care programs refer to the program specific requirements of the department for further specifications on experience and educational expectations, including continuing education requirements.

Any physical requirements reported by a prospective employee and/or employee's physician or delegate will be considered for accommodations.

PAY RANGE:

$74,900.00 - $107,000.00

CITY:

Rochester

POSTAL CODE:

14607

The listed base pay range is a good faith representation of current potential base pay for a successful full time applicant. It may be modified in the future and eligible for additional pay components. Pay is determined by factors including experience, relevant qualifications, specialty, internal equity, location, and contracts.

Rochester Regional Health is an Equal Opportunity/Affirmative Action Employer.Minority/Female/Disability/Veterans by a prospective employee and/or employee's Physician or delegate will be considered for accommodations.