Department: Quality Improve - Education
12801 Westlinks Drive
Shift: Shift 1
8:00:00 AM to 4:30:00 PM
Fort Myers, FL 33913
Work Type: Full Time
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.
|Degree/Diploma Obtained||Program of Study||Required/|
|Minimum Years Required||Area of Experience||Required/|
|2 Years||Case Management||Required|
|Registered Nurse License||Required||or|
|Physical Therapist License||Required|