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LeeHealthCareers

Career Paradise

ca·reer par·a·dise | /ke’rir ,pere’dīs/ noun

Clinical Resource Specialist-HH

Job Details

Location:
Fort Myers, FL

Category:
Home Health Services

Type:
Full Time

Schedule:
Days

Job Ref:
7886

Location: Westlinks

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Department: Quality Improve - Education

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Workdays/Nights: Days

12801 Westlinks Drive

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Shift: Shift 1

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8:00:00 AM to 4:30:00 PM

Fort Myers, FL 33913

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Work Type: Full Time

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Exempt: Yes

Job Summary

Summary:

Office Based position that is responsible for the following:

• Participates in improving the overall integrity of clinical documentation. Reviews clinical data upon admission, recertification, transfer, resumption of care and discharge for documentation consistency with Plan of Care, acuity level, service appropriation and completeness.

• Reviews visit utilization for appropriateness of care guidelines and patient condition; reports potential financial losses and/or underutilization to the clinical manager/designee.

• Reviews visit documentation for adequate skill and progression towards established goals.

• Notifies organization leadership of problematic trends as a result of OASIS review.

• Makes corrections, where appropriate, in collaboration with the clinical case manager.

• Collects and summarizes data related to inconsistencies and designs, develops and implements interventions and supporting reference materials/modules to address.

• Concludes medical necessity and appropriateness of services using clinical review criteria.

• Applies clinical knowledge to work with facilities and providers for care-coordination.

• Prospectively reviews all OASIS assessments to ensure appropriateness, completeness, and compliance with federal and state regulations and organization policy.

• Participates in Quality Improvement and Corporate Compliance activities as assigned.

• Performs utilization management functions that assure regulatory compliance, medical necessity and appropriate level of care.

• Provide teamwork, flexibility and professionalism in this role which will include covering team members PTO, and other requested tasks as needed.

Job Requirements

Responsibilities:

Educational Requirements

Degree/Diploma ObtainedProgram of StudyRequired/
Preferred
and/or
Bachelor'sNursingRequiredor
Master'sPhysical TherapyRequired

Experience Requirements

Minimum Years RequiredArea of ExperienceRequired/
Preferred
and/or
2 YearsCase ManagementRequired

Additional Requirements

Qualified individuals will successfully complete the competency assessment; two year Home Health case manager experience

State of Florida Licensure Requirements

LicensesRequired/
Preferred
and/or
Registered Nurse LicenseRequiredor
Physical Therapist LicenseRequired

Certifications/Registration Requirements

Certificates/RegistrationsRequired/
Preferred
and/or

Additional Requirements

US:FL:Fort Myers



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