Quality Improvement Coordinator (RN) - HomeCare
Company: Hartford Healthcare
Location: East Hartford
Posted on: May 25, 2023
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Job Description:
Description Job Schedule: Full Time Standard Hours: 40 Job
Shift: Shift 1 Shift Details:
Work where every moment matters.
Every day, almost 30,000 Hartford HealthCare employees come to work
with one thing in common: Pride in what we do, knowing every moment
matters here. We invite you to become part of Connecticut's most
comprehensive healthcare network as a Quality Improvement
Coordinator.
Hartford HealthCare at Home, the largest provider of homecare
services in Connecticut, has been fulfilling our mission for more
than 115 years. Our Person-Centered Care Model allows our employees
to learn and grow within our organization, all while providing
integrated support to the patient. As part of Hartford HealthCare,
we leverage cutting edge technology to provide quality care in our
client's home. Most importantly, our employees are appreciated for
the real differences they make in both the lives of their clients
and their clients' families.
Basic Purpose of the Position:
** Manages appeals at the branch level including clinical
documentation review, training, and guidance of clinical staff to
ensure accurate reimbursement, regulatory compliance and the
delivery of outcome-based, quality, cost effective care.
In general, most of the time will be spent in the following
activities:
**Monitor Advanced Beneficiary Notices and denials as it relates to
medical necessity requirements.
**Identify and evaluate denials to determine specific issues and
patterns that need to be addressed with the facility.
**Investigate all payer denials and take appropriate action
including but not limited to appeals, corrected billing
and chart reviews.
**Document patient accounting system with all denial activity and
actions taken.
**Compile monthly denial reports.
**Maintain all data elements related to denials in the Compliance
360 module.
**Other duties as assigned by supervisor
**Facilitates record audits and process of care investigations,
trends outcome data (satisfaction, utilization and clinical),
develops and implements plans of action to ensure quality
improvement, reimbursement and regulatory compliance.
**Reviews, calculates, and analyzes identified data processed by
other team members as it relates to clinical documentation and
quality of care. Develops and facilitates performance improvement
teams and quality initiatives across the agency.
** Assist Quality teams with adverse event investigations, root
cause analysis and development of best practices for the
agency.
** For clinicians identified by Clinical Team Manager and Clinical
Development Specialists provide reviews and processes
certification/recertification and resumption of care orders
ensuring accurate documentation and appropriate development of the
plan of care.
** Collaborates with Clinical Team Manager and other case managers
to support the Patient Centered Care Model including case
conferencing, review of documentation and focused education to the
clinical team.
** Provides staff guidance in making clinical and case management
decisions that are cost effective and focused on clinical outcomes
and operational performance indicators.
** Conducts education and training sessions related to utilization,
reimbursement and regulatory compliance.
** Performs monthly pre-billing audits for Medicare, Medicare and
Hospice
** Takes the lead on Additional Documentation Requests (ADR),
government and payer audits to ensure documentation supports payer
requirements and to ensure submission is timely
** Develops training to staff to improve clinical documentation
** Ensures standard work minimizes risk for denials
** Participates in quality assurance audits, audits, appeals and
committees & projects as needed.
** Demonstrates the ability to research regulations and legal
requirements on reimbursement issues and to train staff
appropriately.
** Demonstrates the ability to work well with others and to educate
clearly and concisely.
** Maintains a flexible schedule to meet the needs of the
agency.
Qualifications
Licensure: Registered Nurse with a license to practice in the State
of Connecticut
Education: Graduate of an Associates degree or diploma program in
Nursing; graduate of National League of Nursing-approved BSN
program, preferred
Experience: Three years clinical homecare experience. Managed care
or case management experience required. Proficient in Oasis, record
review, home care regulations and use of quality tools. Computer
literate. Demonstrated ability to work with teams and individuals
in providing clear, understandable direction and guidance.
Excellent written and verbal communication skills.
We take great care of careers
With locations around the state, Hartford HealthCare offers
exciting opportunities for career development and growth. Here, you
are part of an organization on the cutting edge - helping to bring
new technologies, breakthrough treatments and community education
to countless men, women and children. We know that a thriving
organization starts with thriving employees-- we provide a
competitive benefits program designed to ensure work/life balance.
Every moment matters. And this is your moment.
Keywords: Hartford Healthcare, East Hartford , Quality Improvement Coordinator (RN) - HomeCare, Healthcare , East Hartford, Connecticut
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