Clinical Services Review Nurse UM Review RN in Augusta, GA at US CareNet

Date Posted: 10/7/2019

Job Snapshot

  • Employee Type:
  • Location:
    Augusta, GA
  • Job Type:
  • Experience:
    Not Specified
  • Date Posted:

Job Description

 Job Description Summary:

The Clinical Services Review Nurse is a qualified Home Healthcare professional who performs ongoing client/patient chart and other supporting documentation reviews and audits to ensure quality and compliance as well as occasional on-site agency assessments. These responsibilities will be carried out to ensure compliance with agency requirements, established policies and state and federal guidelines under the supervision of the Director of Clinical Services.

Essential Job Functions/Responsibilities:

  1. Prospective review of OASIS assessments to include: Start of Care, Resumption of Care, Re-certification, follow-ups and add-ons to ensure appropriateness, completeness, and compliance with state and federal regulations.
  2. Ensures appropriate ICD-10 Coding and sequencing as it relates to the patient’s medical condition, including any co-morbidities and current guidelines.
  3. Reviews Face to Face for required elements and verifies diagnosis is related to the home health focus for care.
  4. Consults with the appropriate designee to clarify any data integrity issues and/or corrections to documentation; documents same in the medical record.
  5. Makes recommendations to revise immediate and long-term therapeutic goals and in developing the plan of care to adhere with policies and accreditation requirements.
  6. Reports potential financial losses and/or under utilization to the Clinical Manager/designee
  7. Notifies agency leadership of problematic trends noted in OASIS documentation as a result of Oasis review.
  8. Stays informed about changes in the field of home health care, including state and put space between federal and regulations federal regulations. Attends conferences and shares that information with staff as appropriate.
  1. May assist with other chart audit activities as needed.
  2. Maintains a specific productivity standard as monitored by the Director of Clinical Services.

Position Qualifications:

 1.    Registered Nurse (RN) required. 

2.    Obtain and maintain RN licenses for all States serviced by the organization. 

3.    Working knowledge of state and federal regulations for home health agencies and an understanding of home health policies.  

4.    Two (2) years of home health or Medicare reviewer experience preferred. 

5.    HCS-D (Home Health Coding Certification) and COS-C (Certified OASIS Specialist-Certified) Certification strongly preferred. Will be required to obtain COS-C certifications within 6 months of hire. 

6.    Demonstrated strength in documentation skills, both oral and written. Demonstrated ability to motivate and educate others. 

7.    Working knowledge of computer systems. 

8.    Ability to complete assignments timely and meet organizational deadlines. 

9.    Ability to adapt to changing organizational needs.  

10.  Disposition to work harmoniously with departmental staff, as well as other agency employees and clients. Excellent customer service skills. 

11.  Detailed-orientated and able to work independently to meet deadlines. 

12.  Position requires occasional travel to agencies for on-site reviews of agency clinical and operations staff and/or to assist in covering operations vacancies.