Quality Review Specialist

Job Description:Title: Quality Review SpecialistDivision: Senior ServicesStatus: ExemptReports to: Regional Director of Ops, Home HealthRevision date: January 2025Supervises: n/aPURPOSEAccording to prescribed policies and procedures of the organization including all applicable state, federal and accreditation regulations and under the general supervision of the Regional Director of Ops, has the responsibility for driving and improving quality measures and outcomes within the assigned agencies.ESSENTIAL FUNCTIONSOASIS & Documentation Audits: Perform thorough audits of OASIS assessments and clinical documentation submitted by field staff to ensure accuracy, compliance, and alignment with OASIS guidance and industry standards.Quality Improvement: Track, trend, and report on documentation audit results, identifying areas for improvement. Generate and analyze reports on quality measures, audit results, and compliance, presenting findings to leadership in a clear and actionable format. Develop and implement corrective action plans to address deficiencies and enhance the overall quality of care. Actively participate in the QAPI program.Regulatory Updates: Monitor changes in regulations and OASIS guidance, bringing these updates to the leadership team and field clinical staff. Provide education and training to prepare staff for regulatory changes, ensuring compliance with the ever-changing regulatory landscape.Staff Education: Provide ongoing education and training to field staff on proper documentation practices, OASIS completion, and coding guidelines to ensure adherence to regulatory and payer requirements.Collaboration with Leadership: Work closely with Directors of Clinical Management and other members of the leadership team to identify opportunities for quality improvement, share audit findings, and ensure consistency in care delivery.Technology Utilization: Use technology effectively, including Microsoft Office Suite, Clinical Comms, Outlook, SHP, and other technology tools, software and website resources. Proficiently navigate and utilize Home Care Home Base (HCHB) EMR & SHP to conduct audits, track trends, and monitor quality indicators.Backup Support: Provide backup support for the Coder and Director of Clinical Management, assisting with tasks and supporting the overall clinical management process when needed.Reimbursement Knowledge: Maintain expert knowledge of what drives reimbursement to proactively prepare the agency for changes in regulations and payer requirements, ensuring that the agency remains in compliance and is prepared for the future. (Example: VBP and the CMS 5 Star system).Attends and participates in regularly scheduled interdisciplinary team meetings to problem-solve, support and perform in-service education with staff.EXPECTATIONSDemonstrates and maintains a positive, professional manner, manages time efficiently and effectively, provides leadership as a role model to promote a team approach, collaborates and participates in policy creation and appropriate problem solving methods.Must adhere to all policies, procedures, terms and conditions set forth in the National Church Residences' Employee Information Guide (EIG), the Code of Conduct, as well as any facility handbook, including but not limited to, corporate compliance, drug free workplace, safe work practices, all federal, state, local regulations and laws.With respect to Client Rights, ensures all care is provided with respect and dignity for the residents/clients, their families and the staff. Reports all complaints made by residents/clients and/or families to the appropriate supervisors, reports all allegations of abuse, misappropriation of funds/resident property and/or any other corporate compliance, drug free workplace, safe work practices, all federal, state and local regulations and laws.

Created: 2025-09-12