Quality Assurance Specialist (RN) - Home Health

The OASIS Review Nurse is a professional, registered 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 the agency. 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. Consults with appropriate clinical staff to clarify any data integrity issues and works with clinician to make appropriate corrections per the agency. Reviews visit utilization for appropriateness of care guidelines and patient condition; reports potential financial losses and/or underutilization to the Clinical Supervisor/designee. Notifies the agency leadership team 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. Participates in Quality Improvement and Corporate Compliance activities as assigned. Assists with other chart audit activities as assigned. Maintains professional and technical knowledge by attending educational workshops and reviewing professional publications. Other quality improvement tasks as needed The above statements are only meant to be a representative summary of the major duties and responsibilities performed by the employee of this job. The employee may be requested to perform job-related tasks other than those stated in this description.