Clinical Record Reviewer (RN) – Home Health Remote

Manages and supports quality and performance improvement by assisting staff to implement strategies that identify, prioritize, measure, and improve key clinical processes and outcomes. Reviews patient records to determine the complete, accurate, and timely documentation of all conditions that support home health/hospice care and treatment of the patient. Reviews and interprets patient records and compares against criteria to determine medical necessity and appropriateness of care. Consults with providers, management, and operations to ensure consistency within the application of clinical criteria. Utilizes clinical expertise for the review of medical records against appropriate criteria in conjunction with contract requirements. Maintains current knowledge of clinical indicators and compliance requirements. Manages tools to collect outcome data and provides regular feedback to individuals, managers, and leaders. Provides concurrent medical record review to assess documentation compliance. Facilitates recommended interventions. Reviews deficiencies in documentation with involved staff and facilitates corrective action. Participates in the ongoing development and implementation of an established performance improvement plan. Reviews orders for data entry, completeness, and appropriateness for admission to home health/hospice services. Promotes, obtains, and reviews appropriate documentation for any home health/hospice specific quality data. Minimum Qualifications: Associate’s Degree in Nursing. 2 years Experience as a Registered Nurse. Ability to work cross functionally across remote teams. Demonstrates a working knowledge of Medicare guidelines for hospice coverage. Demonstrated track record of continuous quality improvement. Proficient in prioritizing work and delegating where indicated. Certifications required within 1 year: HCS-D, HCS-O, COS-C, and RN license in Pennsylvania. Preferred Qualifications: Bachelor’s Degree in Nursing. Hospice and home care experience and documentation experience or coding experience. Physical Demands include lifting and carrying 25 lbs, frequent sitting/standing, frequent keyboard use, and patient care activities as applicable. The position is remote in Pennsylvania with a day shift schedule Monday-Friday 8-4:30p.