Functioning within the Hospital’s mission, values, objectives, and policies and procedures the Home Care Quality Case Manager is a registered nurse appropriate patients to facilitate achievement of quality and cost-effective patient outcomes. Works collaboratively with interdisciplinary staff, internal and external, to the organization regarding home care coordination. Participates in Performance/Quality Improvement and evaluation process related to the management of home care referrals, their discharge process and patient outcome monitoring. Reviews OASIS documentation and codes accordingly. Assists with education of home health staff regarding payor source rules, regulations, and documentation requirements.
Education: Must be a graduate of an accredited school of nursing. A BSN is required or must be obtained within 18 months of hire.
Licensure/Certification: A valid, unrestricted RN license from the Ohio Board of Nursing is required. BLS is required.
Experience: Minimum of two (2) years medical surgical and home health care experience are required. Previous supervisory and home health care program administration are strongly preferred. QA/PI and ICD-10coding experience required.
Skills: Knowledge of pertinent and current home care industry and varied payor source regulations, standards and guidelines required. Must demonstrate strong communication skills, diplomacy, and the ability to work effectively both independently and within an interdisciplinary team environment. Proficiency with most recent version of OASIS required. Must also have a working knowledge of insurance contracts and how they impact on the continuum of care; the role of State and Federal governmental agencies as they relate to healthcare; age and cultural differences unique to the patients served; and nursing management of disease processes.
PI270402653
