Quality Review (LVN) : Home Health

Primary Duties and Responsibilities

• The Quality Review Nurse is a professional, licensed vocational nurse responsible for analyzing data integrity and consistency of OASIS documentation and assessment processes.
• This position will ensure appropriate ICD-10 coding and sequencing and will work with clinical staff to clarify documentation and data integrity issues.
• Prospectively reviews all OASIS assessments to ensure appropriateness, completeness, and compliance with federal and state regulations and organization policy.
• Utilizes OASIS variation or alert reports when reviewing OASIS data.
• Ensures appropriate ICD-10 coding and sequencing as it relates to the patient’s medical condition, including any co-morbidities.
• Reviews visit utilization for appropriateness of care guidelines and patient condition; reports potential financial losses and/or underutilization to the clinical manager/designee.
• Notifies organization leadership of problematic trends as a result of OASIS review.
• Works with managers to address trends that affect the agency’s outcome and process measures noted during OASIS review.
• Makes OASIS inter-rater reliability visits with clinical staff.
• Performs other duties as assigned.

Qualifications

Education and Experience

• High School diploma or equivalent.
• One (1) to two (2) years of clinical experience required.
• Working knowledge of OASIS and ICD-10 coding. OASIS certification (COS-C) preferred; OASIS Home Health ICD-10 coding certification preferred.
• Knowledge of federal regulations and state licensure requirements.

License Required

Current LVN License to practice in the State of California

License Preferred

N/A

Certifications Required

Current BLS Certification

Certifications Preferred

N/A