Hartford HealthCare at Home is looking for a Quality Safety Clinician to manage the review of clinical documentation and assists in the training of clinical staff to ensure accurate reimbursement, regulatory compliance and the delivery of outcome-based, cost effective care.

Job Duties:

• 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.
• When indicated, reviews and processes certification/recertification and resumption of care orders ensuring accurate documentation and the development of an accurate plan of care with appropriate visit patterns and disciplines.
• Identifies areas for process improvement based on quality assurance and outcome studies
• results, and internal and external record review
• Collaborates with clinical supervisors and other case managers to identify agency trends based on the review of documentation and to develop and implement plans to address trends.
• 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.
• Participates in post payment reviews, compliance and claim audits, and assists with record reviews, audits and appeals as needed.
• Participates in quality assurance audits, 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

Registered Nurse with a license to practice in the State of Connecticut

Graduate of an Associates degree or diploma program in Nursing; graduate of NLN-approved BSN program, preferred

Three years clinical homecare experience.

Managed care or case management experience required.

Familiar with OASIS, home care regulations.

Computer literate