Registered Nurse, Quality Assurance / Case Manager, ( RN )

AW Health Care; St. Louis (MO); On-site; USD 65,000 - 85,000; Full time

Benefits offered by this job

Medical

Dental

Vision

401K with 4% Match

Paid Time Off

Life Insurance

Short Term Disability

AD&D

Critical Illness

Job summary

AW Health Care seeks a dedicated Quality Case Manager (RN) to lead quality and clinical management of patients in MO/IL. You will develop care plans, monitor outcomes, and report on quality initiatives in collaboration with administrative staff.

Responsibilities include chart reviews, ensuring regulatory compliance, and coordinating quality improvement activities. Requires current MO license (or IL/compact) and experience in home health settings.

Qualifications

• Active RN license in MO or IL, or compact license valid in MO.
• Two years of home health management experience preferred.
• Understanding of Medicare reimbursement guidelines and other payors.
• Strong interpersonal and communication skills.
• Current licensure as a registered nurse in practicing state(s).
• Valid driver’s license and auto insurance.

Responsibilities

• Maintain knowledge of HIPAA regulations and compliance issues.
• Proficient with OASIS data and related documentation.
• Adhere to AW Health Care policies and procedures.
• Assist staff in reconsideration of denials and review trends.
• Coordinate Quality Improvement Plan and quarterly peer reviews.
• Provide education and orientation to new personnel and students.
• Ensure documentation quality and regulatory compliance across chart reviews and visits.

Skills

Home health management experience

Medicare guidelines knowledge

Interpersonal communication

Education

Graduation from an accredited school of nursing

Job description

Must have an active RN license in MO or IL, or a compact license valid in MO.

AW Health Care is a St. Louis based, independently operated, women-owned enterprise. We recently celebrated our 20th anniversary in the home health industry. AW is a rapidly growing home health agency, with an innovative approach to patient centered care. Our team consists of over 400 employees serving over 1500 patients in Missouri and Illinois.

AW Health Care Benefits: AW Health Care offers its' employees a wide range of benefits including:

• Medical
• Dental
• Vision
• 401K with 4% Match
• Paid Time Off

And a wide range of supplemental benefit options including, but not limited to:

• Life Insurance
• Short Term Disability
• Accidental Death and Dismemberment
• Critical Illness
• Hospital Indemnity

Job Summary:

The Quality Case Manager is a registered nurse who is responsible for all tasks related to Quality and Clinical Management of patients. This includes ensuring that an individual plan of care is developed which promotes self-care and quality of life through efficient resource utilization. This person is responsible for developing, implementing, monitoring, tracking and reporting on quality assurance projects and quality initiatives for AW Healthcare patients. This person performs chart review to ensure proper utilization of services to meet patient care needs and regulatory compliance through the use of quality indicators, which are developed in collaboration with the administrative staff.

Responsibilities:

1. Maintains a knowledge base of current HIPAA/regulatory/compliance issues
2. Knowledgeable and proficient regarding OASIS data and other needed documentation
3. Knowledgeable and adheres to AW Healthcare policies and procedures.
4. Knowledgeable and proficient in the use of computer software programs in use by AW Healthcare.
5. Assists and supports staff in reconsideration of denials.
6. Conferences with staff as needed regarding documentation and any identified areas of concern in service utilization or regulatory compliance.
7. Tracks problems/concerns/weak areas noted in reviews and reports trends and in-service needs.
8. Updates supervisor and field staff to trends that are identified in chart review.
9. Promotes agency services and programs by participating in public relations efforts or community activities.
10. Recognizes limitations and conferences with supervisor/designee as needed.
11. Attends and actively participates in staff meetings and assigned committees.
12. Understands and actively participates in performance improvement program.
13. Designs, reviews, updates and implements Quality Improvement Plan annually, while monitoring and reporting progress quarterly.
14. Coordinates quarterly peer review.
15. Prepares written summary of Quality Indicator findings of internally benchmarked standards as well as State and National performance indicators and makes recommendations for presentation to the Governing Body and staff.
16. Provides orientation education and direction to new personnel, students, and home care aides.
17. Provides education to staff on documentation guidelines, performance improvement for staff from identified deficiencies.
18. Assures documentation quality with regard to regulatory compliance, utilization of services, timeliness and completeness of submitted OASIS assessments, visit notes, supervisory activities and supporting documentation.
19. Adheres to HIPAA regulations, educates staff as needed on relative HIPAA requirements and non-adherence to standards is identified to appropriate supervisor immediately.
20. Participates in staff meetings and in-services, as appropriate; completes annual mandatory in-services and maintains current CPR certification
21. Performs direct patient care as directed and as staffing patterns warrant per nursing practice act scope of practice as needed
22. Assists and supports other staff in completion of job duties as needed or assigned.

Reporting Structure:

Reports to the Manager, Quality Assurance.

Working Environment:

Works in home or company office setting. May perform patient care as needed during short staffing.

Exposure Risk:

High Risk

Requirements

Qualifications:

• Graduation from an accredited school of nursing, and currently licensed in the State of Missouri
• Two years of experience in home health management preferred.
• Good understanding of Medicare reimbursement guidelines and other third party payors.
• Possesses good interpersonal relationship and communication skills.
• Current licensure as a registered nurse in the state(s) in which practicing
• Requires current state issued driver’s license, current motor vehicle insurance coverage and a motor vehicle in working condition.

Physical Requirements:

Ability to perform the following tasks if necessary:

• Ability to participate in physical activity.
• Ability to work for extended period of time while standing and being involved in physical activity.
• Ability to do extensive bending, lifting and standing on a regular basis.