Home Health Quality Specialist

At Lancaster General Health, our culture is what sets us apart and creates a lasting impression of our health system in the community and in the hearts of our patients and their families. A role with us is more than just a job, we ask that you Live Your Legacy at LGH by finding your passion in your everyday role, committing to those you serve, and reaching for your personal best.We are recognized as 1 of only 9 hospitals in the entire country with awards in Medicare.Gov, LEAPFROG and Healthgrades Americas 50 Best Hospitals. We have attained four-year Magnet ® recognition status for the fourth time with the American Nurses’ Credentialing Center (ANCC) and we are the 2018 recipient of the Foster G. McGaw Prize in recognition of the commitment to community service.PENN MEDICINE LANCASTER GENERAL HEALTH offers a comprehensive benefits package:We believe that the best care for our patients starts with the best care for our employees. Our employee benefits programs help our employees get healthy and stay healthy. We offer a comprehensive compensation and benefits program so that our employees can stay actively engaged and committed to living their legacy every day. Together, we will continue to make medical advances that help people live longer, healthier lives.Join us and be part of a team that empowers you to do more than your job and encourages you to:Live Your Passion. Live Your Best. Live Your Commitment. Live Your Legacy.CompanyAffilia Home HealthCost Center2015 Administration/Shared ServicesSupervisory OrganizationQuality Compliance and EducationGradeG15Benefits of Joining Penn Medicine Lancaster General Health:PENN MEDICINE LANCASTER GENERAL HEALTH combines a Nationally Ranked Hospital with great schools, safe neighborhoods, affordable housing, local community events and festivals as well as a wealth of cultural and recreational activities. The scenic Susquehanna River Valley provides opportunities for fishing, skiing, kayaking, hiking and mountain biking in addition to easy access to NJ shoreline or Delaware beaches. Urban life is easily accessible, with New York, Baltimore, Philadelphia and Washington D.C. a train ride away. Local universities, Fulton Theatre, the downtown shopping and dining district and local sports teams make Lancaster a great place to Live, Work and Play.SummaryPOSITION SUMMARY:The Home Heath Quality Specialist would is responsible for collaborating with clinicians at established points in time to assure accurate completion of assessments and development of effective plans of care to assure appropriate utilization and promote appropriate quality patient care and positive patient outcomes.ESSENTIAL FUNCTIONS: Qualified individuals must have the ability (with or without reasonable accommodation) to perform the following duties:

Assure accuracy of assessment documentation and development of the Plan of Care (485’s) by reviewing all admissions for appropriateness, reviewing clinical assessments with clinical staff to determine patient needs, reviewing reliability of functional score as needed, and reviewing primary diagnosis codes for alignment with POC and reason from Home Health episode.

Reviewing and Analyzing OASIS data to ensure accuracy. Reviewing utilization orders and POC for alignment and appropriateness of care.

Ensure patients meet home care admission requirements. Collaborate with clinicians to confirm assessment documentation and Plan of Care support Home Health criteria. Review accuracy of visit frequency according to orders and agency guidelines.

Ensure ongoing proper utilization of resources by reviewing all PDGM episodes (including resumptions and recerts), reviewing the decision support system reports and all related alerts, and advising staff regarding the need for SCIC assessments if there are changes in condition.

Review and collaborate with clinician(s) on any variation from the Oasis, POC and authorized visits. Upon discussion with clinical staff, approve updates or changes.

Collaborate with clinical staff, clinical supervisors and managers to facilitate accurate and thorough care planning throughout the patient's episode of care; Notify managers of discrepancies and inconsistencies.

Serve as a resource to staff related to clinical assessment of patients and the need for appropriate interventions (therapy, nursing, HHA and social work)

Identify cases for interdisciplinary case conferences for assigned team(s) and attend as indicated. Participate in re-certification conferencing as needed.

Collaborate with clinical supervisors/managers in the education process for clinical staff by communicating staff performance issues to clinical manager. Participate in department and team meetings to provide education to staff on compliant documentation and regulatory updates

Perform joint home visits with staff requiring additional education and identified high risk cases related to assure OASIS and POC documentation competency. Also provide joint home visits with new employees.

Proficient use of Home Care Information System and Decision Support software. Prepares, distributes and presents reports related to utilization of care and clinical outcomes as needed;

Performs comprehensive chart audits as needed to identify performance improvement needs. Develop appropriate education and monitoring to ensure clinical excellence and quality patient care objectives are achieved.

Monitors key agency reports to manage quality review process.

SECONDARY FUNCTIONS: The following duties are considered secondary to the primary duties listed above:· Ensures compliance with all federal, state, and local regulatory standards and requirements.

May be required to perform clinical field-staff role as needed.

Other duties as assigned.

JOB REQUIREMENTSMINIMUM REQUIRED QUALIFICATIONS:

Bachelor’s Degree in Nursing from an accredited school of nursing OR Bachelor’s Degree in Physical Therapy from an accredited school of physical Therapy.

Currently licensed as a professional Registered Nurse or Physical Therapist in the state of Pennsylvania.

Two (2) or more years of experience working with Medicare Regulations for OASIS, compliance, and coding and/or experience in home care criteria and processes related to Managed Care.

PREFERRED QUALIFICATIONS:

COQS or equivalent Oasis certification from accredited agency at the time of hire or agreement to have within one year of acceptance.

COGNITIVE REQUIREMENTSAttention/Concentration: The following level of ability is essential for the jobholder to focus on certain aspects of current experience and reject others.The position requires the ability to attend to more than one aspect of a situation simultaneously. It is highly likely that multiple task demands are going to be required of the individual at the same time.New Learning and Memory: The following level of ability is essential for the jobholder to learn and retain material.Job demands are only moderately routine and predictable. Minor changes may occur which require the individual to be able to understand and carry out detailed but uninvolved instructions.Problem Solving, Reasoning and Creative Thinking: The following level of ability that is essential for the jobholder to think (in order to solve a problem) by combining two or more elements from past experience or imaginative thought.The requirement for autonomous problem solving or creativity of thought in the position is minimal. Problems encountered tend to involve a few concrete variables in or from standardized situations. Typically involves adhering to a chart or set procedure.APTITUDES: The following are essential requirements of the position in relation to job-worker situations. These items describe how a worker must adapt, adjust, conform or act.Variety and change: Ability to perform a variety of duties, often changing from one task to another of a different nature without loss of efficiency or composure involving significant differences in technologies, techniques, procedures, environmental factors, physical demands, or work situations.Communication: Ability to exchange information with others clearly and concisely; to present ideas, facts and technical information.Interpersonal relations: Ability to maintain relationships that facilitate task accomplishment; to cooperate and resolve conflicts; to recognize needs and be sensitive of others.EQUIPMENT USAGE REQUIREMENTSEquipment/Tools: Computer, Phone, Copier, Printer, Fax, Office SuppliesSoftware: Microsoft Office ProductsPHYSICAL REQUIREMENTSRarely 0-10%; Occasionally 11-35%; Frequently 36-70%; Continuously 71-100%Body Position/Movement :

Sit: Continuously

Stand: Occasionally

Walk: Occasionally

Bend: Rarely

Push: Rarely

Pull: Rarely

Kneel/Squat: Rarely

Reach: Occasionally

Twist: Occasionally

Balance: Frequently

Climb: Rarely

Lifting: Degree of physical exertion is: Light , exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to move objects.Sensory Abilities specifically required:

Vision

Hearing

Touch/Feeling

PHYSICAL ENVIRONMENTWORKING CONDITIONS:Exposure to hazardous conditions/ materials is negligible.Disclaimer: This job description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills, efforts, or working conditions associated with the job. It is intended to be a reflection of those principal job elements essential for recruitment and selection, for making fair job evaluations, and for establishing performance standards. The percentages of time spent performing job duties are estimates, and should not be considered absolute. The incumbent shall perform all other functions and/or be cross-trained as shall be determined at the sole discretion of management, who has the right to amend, modify, or terminate this job in part or in whole. Incumbent must be able to perform all job functions safely.DisclaimerPENN MEDICINE LANCASTER GENERAL HEALTH is an Equal Opportunity Employer, committed to hiring a diverse workforce. All openings will be filled based on qualifications without regard to race, color, sex, sexual orientation, gender identity, national origin, marital status, veteran status, disability, age, religion or any other classification protected by law.Search Firm Representatives please read carefully: PENN MEDICINE LANCASTER GENERAL HEALTH is not seeking assistance or accepting unsolicited resumes from search firms for this employment opportunity. Regardless of past practice, all resumes submitted by search firms to any employee at PENN MEDICINE LANCASTER GENERAL HEALTH via-email, the Internet or directly to hiring managers at Penn Medicine Lancaster General Health in any form without a valid written search agreement in place for that position will be deemed the sole property of PENN MEDICINE LANCASTER GENERAL HEALTH, and no fee will be paid in the event the candidate is hired by PENN MEDICINE LANCASTER GENERAL HEALTH as a result of the referral or through other means.PENN MEDICINE LANCASTER GENERAL HEALTH, a member of the University of Pennsylvania Health System (Penn Medicine), is a not-for-profit health system with a comprehensive network of care encompassing Lancaster General Hospital (LGH), Women & Babies Hospital and the Lancaster Rehabilitation Hospital (a partnership with Kindred Healthcare). We are an Accredited Trauma Center-Level II through the Pennsylvania Trauma Systems Foundation with 805 Licensed beds. Our membership in Penn Medicine brings together the strengths of a world-renowned, not-for-profit academic medical center and a nationally recognized, not-for-profit community healthcare system.Outpatient services are provided at the Downtown Outpatient and Suburban Outpatient Pavilions, along with additional outpatient centers and Express and Urgent Care locations throughout the region. Lancaster General Health Physicians is a network of more than 300 primary-care and specialty physicians, at more than 40 offices throughout the region.