QAPI Clinical Review RN

Optum; Las Vegas (NV); Hybrid; USD 73,000 - 130,000; Full time

Benefits offered by this job

Sign-on bonus

Job summary

OptumCare is hiring a Clinical Review RN in Nevada to support quality initiatives through comprehensive medical record review and OASIS data integrity. You will work with clinical staff to clarify documentation, ensure ICD-10 sequencing, and implement agency-wide QAPI programs.

The role includes collaboration with providers and a hybrid schedule with three days in office and two days at home. The ideal candidate has an unrestricted Nevada RN license, 3+ years in home health, and strong knowledge

Qualifications

• Current, unrestricted Nevada RN license (or temporary with ability to obtain permanent licensure)
• BLS CPR certification
• 3+ years of clinical RN experience, preferably in Home health
• Medical record review and chart abstraction experience
• Proven working knowledge of OASIS and ICD-10 coding
• Proven knowledge of federal regulations and state licensure requirements
• Proven excellent coordination and communication skills
• Experience educating physicians, registered nurses, and/or clinical staff
• Experience working with Electronic Medical Records (EMR) systems
• Driver's license with automobile in good working order and insurance
• Ability to work three days in office and two days at home

Responsibilities

• Reviews all OASIS assessments for timeliness, completeness and compliance
• Utilizes OASIS variation or alerts in review
• Ensures ICD-10 coding sequencing relates to Admission summary
• Clarifies data integrity issues with clinical staff and corrections
• Notifies leadership of problematic trends from OASIS review
• Addresses trends affecting outcomes and process measures
• Participates in Quality Improvement and Corporate Compliance activities
• Maintains knowledge by attending workshops and reviewing publications
• Participates in Administrator on-call rotation
• Develops and implements agency-wide QAPI program via data collection, analysis and benchmarking
• Prepares and presents QAPI reports to leadership
• Serves as resource for EHR system and uses Agency tech resources to improve performance
• Fosters culture of clinical excellence with leadership to develop policies and processes
• Completes inter-rater reliability testing and required training
• Performs quality improvement audits and chart reviews for required data
• Educates physicians, nurses and staff on quality measures and documentation
• Collaborates with internal quality team to drive performance improvements

Skills

RN license

OASIS knowledge

ICD-10 coding

EMR systems

Quality improvement

Communication skills

Home health experience

BLS CPR

Driver's license

Education

Bachelor's degree

Tools

EMR software

Job description

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.

We are currently offering a $10,000 sign on bonus for external candidates!

The Clinical Review QAPI RN plays a critical role in supporting healthcare quality initiatives through comprehensive medical record review, analyzing data integrity and consistency of OASIS Documentation, ensuring appropriate ICD-10 dx sequencing and working with clinical staff to clarify documentation and data integrity issues. Under the direction of the QAPI RN Supervisor, develops and implements agency wide QAPI program focusing on assessment and improvement in clinical care and supporting processes and compliance with state and federal regulation. Working alongside an experienced team of clinical quality professionals, this individual will help ensure accurate and timely data collection, support compliance efforts, and contribute to improving care outcomes across the network. This role offers the opportunity to collaborate directly with providers, clinical teams, and healthcare organizations while making a meaningful impact on quality performance and patient care. This role will also have a hybrid schedule working 3 days in office.

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $72,800 to $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

Primary Responsibilities:

• Reviews all OASIS assessments to ensure timeliness, appropriateness, completeness and compliance with federal and state regulations
• Utilizes OASIS variation or alert reports when reviewing OASIS data
• Ensures appropriate ICD-10 coding sequencing as it relates to the Admission summary
• Consults with appropriate clinical staff to clarify any data integrity issues and works with clinician to make appropriate corrections
• Notifies agency leadership of problematic trends as a result of OASIS review
• Works with Clinical Leadership to address trends that affect the agency's outcome and process measure noted during OASIS review
• Participates in Quality Improvement and Corporate Compliance activities as assigned
• Maintains professional and technical knowledge by attending educational workshops and reviewing professional publications
• Participates in Administrator on-call rotation
• Assists in the development and implementation of an agency wide QAPI program via data collection, analysis, reporting, and benchmarking
• Prepares and presents reports regarding QAPI activities to agency leadership
• Serves as a resource for the electronic clinical information system; utilizes Southwest Medical Home Health ("Agency") technology resources to derive performance improvement
• In collaboration with Agency leadership, fosters a culture of clinical excellence via continuous assessment and quality of focus on performance improvement; acts as a resource to all levels of staff; participates in development of agency policies and processes; participates in and coordinates state and federal surveys to include corrective action plans and appropriate documentation to support Agency compliance with corrective action plans
• Complete inter-rater reliability testing and required training to support consistent and accurate medical record abstraction
• Perform quality improvement audits and chart reviews to identify and document required clinical information
• Provide education and guidance to physicians, nurses, and other clinical and non-clinical staff on quality measures, documentation practices, and related initiatives
• Collaborate with internal quality team members to drive performance improvement efforts and maintain data integrity

Required Qualifications:

• Current, unrestricted Nevada RN license, or temporary Nevada RN license with the ability to obtain permanent licensure upon expiration
• BLS CPR certification
• 3+ years of clinical RN experience, preferrable in Home health setting
• Medical record review and chart abstraction experience
• Proven working knowledge of OASIS and ICD 10 coding
• Proven knowledge of federal regulations and state licensure requirements
• Proven excellent coordination and communication skills
• Experience educating physicians, registered nurses, and/or clinical and non-clinical staff
• Experience working with Electronic Medical Records (EMR) systems
• Driver's License with automobile in good working order and maintain personal auto insurance coverage in accordance with organization requirements
• Ability to work three days in office and two days at home

Preferred Qualifications:

• Bachelor's degree
• Oasis Certification (COS-C) preferred. Home Health ICD-10 coding certification
• 2+ years of clinical quality experience, preferably in Home health
• HEDIS data collection experience
• Experience conducting medical record audits and documenting clinical information to support quality and compliance requirements
• Knowledge of healthcare quality improvement methodologies and regulatory standards

OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.