Title:  RN Quality Manager | Home Care Administration | FT Day Job

Summary

Responsible for coordination and administration of regulatory and accreditation readiness.  Ensures the provision of quality services consistent with applicable standards of clinical practice, state and federal laws and regulations, and company policies and guidelines. Provides education for clinical processes and documentation requirements, and guides the implementation of new processes, procedures, and methods. Models appropriate behavior as exemplified in MLH Mission, Vision and Values.

Education/Experience/Licensure

Knowledge/Skills/Abilities

• Must be qualified by knowledge and experience to oversee the services provided in the assigned department/business unit.
• Demonstrates knowledge of federal, state, and local regulations and industry standards related to patient care services provided.
• Strong professional, organizational, and interpersonal skills required for effective and creative leadership in working with all levels of the organization.
• Ability to lead and motivate individuals and groups toward the accomplishment of organizational goals.
• Possesses good analytical and problem solving skills.   Demonstrates a high level of organizational skills to establish and manage priorities and maintain follow-up.
• Demonstrates initiative, flexibility, integrity and diplomacy.
• Proficient in the use of Microsoft applications (such as Word, Excel) and experience with database systems.
• Ability to apply critical thinking skills to identify problems, research alternatives, and recommend solutions.
• Working knowledge of healthcare reimbursement or experience in a similar healthcare administrative role is preferred.
• Work will require ability to read, interpret, and apply regulatory guidelines.

Key Job Responsibilities

Regulatory/Accreditation Readiness

• Responsible for the coordination of accreditation and regulatory standards for the assigned area(s)/business unit.
• Establishes and implements processes to support ongoing compliance and survey readiness. Collaborates with leadership and team members to meet accreditation and compliance goals and objectives. 
• Coordinates compliance audits, survey visits/activities, and post-survey follow-up activities.

• Serves as a change agent to identify, report, and recommend opportunities for improvement in clinical processes and procedures.
• Reviews proposed clinical processes and/or practices to determine implications and whether a new/revised standard is practical or achievable. Evaluates availability and capability of resources and identifies barriers required to fulfill clinical practice standards.

• Guides and coordinates policy/practice review to ensure alignment with regulatory and accrediting standards, best practices, and evidence-based practice.

Medical Record Review & Data Reporting

• Performs supervisory review of patient assessment forms completed by the clinicians for compliance with payor and regulatory data elements.  Ensures documentation is valid, complete, and consistent with these requirements. 
• Monitors patient’s plan of care to ensure sufficient medical documentation meeting payor and regulatory guidelines.  Researches and resolves problems that may impact reimbursement for services.
  • Collects and reports assessment data and plan-of-care documentation electronically to a centralized state data repository.
• Serve as primary contact with physicians/physician offices to collect clinical documentation consistent with regulatory and reimbursement guidelines.
• Stays current in CHAP, Medicare, State, and other payor and regulatory requirements related to services provided.
• Assists with evaluating the quality of care provided by comparing performance with national benchmarks; collaborates with the Director of Quality in the identification, implementation, action planning, and tracking of improvement activities.

Clinical Education

• Develops, delivers, or coordinates standardized clinical education programs to meet existing, new, and revised patient care standards, processes, and regulatory guidelines.  
• Guides the implementation of new processes, procedures, and methods.
• Educates clinicians on appropriate documentation protocols for data collection and documentation.
• Assesses and maintains documentation of staff training and competencies; conducts regular review of continuing education, licensure, and certifications to ensure qualifications are maintained.

Supervisory

• Supervises staff members as assigned within the department.  Monitors Associate performance and clarifies work expectations, and assists with goal setting; promotes cooperation among individuals and groups.  Develops and implements processes through orientation, training and education to ensure that the competence of all staff members is assessed, maintained, improved and demonstrated throughout their employment.

• Plans and schedules work ensuring distribution of assignments and adequate staffing based on workload and productivity standards.

Physical Requirements

• The physical activities of this position may include climbing, pushing, standing, hearing, walking, reaching, grasping, kneeling, stooping, and repetitive motion.
• Must have good balance and coordination.
• The physical requirements of this position are: light work - exerting up to 25 lbs. of force occasionally and/or up to 10 lbs. of force frequently.
• The Associate is required to have close visual acuity to perform an activity, such as preparing and analyzing data and figures; transcribing; viewing a computer terminal; or extensive reading.
• The conditions to which the Associate will be subject in this position: The Associate is not substantially exposed to adverse environmental conditions; job functions are typically performed under conditions such as those found in general office or administrative work.