I believe that better care begins at home. Compassionate care, uncompromising service and clinical excellence thats what our patients have come to expect from our clinicians. Kindred at Home, a division of Kindred Healthcare Inc., is the nations leading provider of comprehensive home health, hospice, and non-medical home care services.
Kindred at Home, and its affiliates, delivers compassionate, high-quality care to patients and clients in their homes or places of residence, including non-medical personal assistance, skilled nursing and rehabilitation and hospice and palliative care. Our caregivers focus on each unique patient to deliver the appropriate care and emotional support to our patients and their families.
I believe my work is my calling.
As a Home Health Quality RN Manager, you will:
Review all Medicare and other episodic payers clinical records at the local level to assure appropriate documentation for reimbursement. This review includes verification of appropriate documentation, quality of care provided, visits utilization, appropriate contacts with physicians, adherence to the care plan, and evidence of communication between disciplines
Oversee the maintenance of clinical records and files to comply with Conditions of Participation (COPs), using measurements, as licensure, certification, and accreditation results
Audit charts for clinical oversight and compliance and adherence to the Medicare guidelines. Identifies clinical problem areas and documents deficiency trends in a proactive approach. Educates administrative and clinical associate staff in the correction of these deficiencies
Assist with quality improvement and Medicare compliance training program. Utilizes Kindred Health Services approved reference materials to resolve inadequacies
Communicate with the Area Education Specialist regarding identified trends of deficiencies with Medicare Conditions of Participation, clinical care, coordination of care, and documentation for the purposes of requiring more extensive education or action of clinical staff
In accordance with the Branch Director, monitor the receipt of Medicare denials, Billing Compliance held claims, and other payer denial notices. Assess the validity of these denials, and responds with additional information. Inform the Branch Director and Branch staff of noticeable trends or relevant issues
In accordance with the Branch Director, prepare and file general appeals on a timely basis. Attend fair hearings as necessary. Collaborate with the Clinical Leadership and clinical associate staff in resolving complex clinical issues
Participate in the initial orientation of the clinical associate staff regarding Medicare Conditions of Participation and relevant requirements for care and documentation and provides education during the orientation in the timeliness of paperwork and flow of OASIS
Collaborate with branch Clinical Leadership to analyze Performance Improvement trends in the delivery of care. Keep up with the performance indicators and monitors the Performance Improvement plan for the branch. Essential in driving performance measures in the branch
Facilitate initiating and gathering the competed CRR tools on a monthly basis and communicates to the Area Education or Area Clinical Specialist when task is completed
Serve as the Chairperson of the Quality Assurance Committee. Conducts the committees quarterly meetings utilizing the Performance Improvement Recommended Timeline as a guide and coordinates and compiles the data for the meetings
Review OASIS documents for accuracy and completeness prior to locking and submitting data electronically. Explain and mentor clinicians and staff on COPs and on billable skilled visits
Educate and mentor clinicians one on one (in person or over the phone) regarding concerns, questions, accuracy of OASIS data, and other related documents, that are being reviewed
Facilitate the ICD-9/10 coding of the Plan of Treatment based on OASIS data and patient assessment documentation that is assessed at the bedside
Collaborate with branch leadership to ensure effective and efficient episodic management, utilizing Kindred Healthcare reports such as Projected vs Actual, PPS Unbilled and Post Billing Adjustment, to identify trends. Collaborate with the Manager Clinical Practice and other clinical and/or branch leadership on clinical staff performance. Provide input to the clinical staff performance evaluation period
Adhere to and participate in Companys mandatory HIPAA privacy program/practices and Business Ethics and Compliance programs/practices and Medicare Billing Requirements program/practices. Review and adhere to all Company policies and procedures and the Employee Handbook. Participates in special projects and performs other duties as assigned
Bachelors degree in Nursing or the equivalent plus
N. Licensure in the state(s) of practice
Three to five years nursing experience, including two years of home healthcare experience within the past five years
Prior ICD-9/10 coding experience is highly desirable
