Title:Quality Assurance Nurse

Department: Home Care & Hospice

FLSA Status: Non-Exempt

Reports To: Director of Patient Care Services/Administrator

Summary: The Quality Assurance Nurse is responsible for evaluating clinical practices within Self-Help Home Care & Hospice and implementing changes for improvement. The Quality Assurance Nurse shall possess Home Health and Hospice Care patient assessment skills, analyzes data integrity and consistency of OASIS documentation and assessment processes, and provides case management, as needed.

Essential Functions:

• Prospectively reviews all OASIS assessments, Plan of Care, Progress Notes, and Physician Orders to ensure appropriateness, completeness, and compliance with Federal and State regulations and organization policy. Utilizes OASIS variation or alert reports when reviewing OASIS data.
• Works with the coding personnel to ensure appropriate ICD-10 coding and sequencing as it relates to the patient’s medical condition, including any co-morbidities, and works with clinical staff to clarify documentation and data integrity issues.
• Consults with appropriate clinical staff to clarify any data integrity issues and works with clinicians to make appropriate corrections per organization policy.
• Notifies department leadership of problematic trends as a result of the OASIS review and works with leadership to address trends that affect the agency’s outcome and processes measures noted during the OASIS review.
• Coordinates and conducts patient care conferences and in-service programs, including identifying the learning needs of clinicians and developing clinical resources for patient care.
• Assists the management team to ensure the maintenance of patient clinical records, statistics, reports and records for purposes of evaluation and reporting of department and organization activities.
• Conducts quarterly record reviews and communicates findings and recommendations in Quality Assurance and Performance Improvement meetings and Professional Advisory Board meetings as assigned.
• Provides clinical review support to the intake process and acts as the backup intake. Completes referral information that includes intake data, essential background information, hospital courses, and the plan of care.
• Acts as a resource to the team and compiles to report quality data in the following areas: patient care, safety, risk management, infection control, outcomes, and customer satisfaction.
• Assists the Hospice Medical Director and Director of Patient Care Services in the planning, implementation, and evaluation of in-service and continuing education programs for the Hospice personnel.
• Completes an initial, comprehensive and ongoing comprehensive assessment of the patient and family to determine hospice/home care needs. Provides a complete physical assessment and history of current and previous illness(es).
• Initiates the plan of care and makes necessary revisions as patient status and needs change.
• Provides medical care, palliates and manages terminal illness in compliance with the State Nurse Practice Act under the supervision of a collaborating physician.
• Assures patient receives appropriate measures to control symptoms, through collaboration with interdisciplinary team members.
• Performs health screening at Residential Care Facilities for the Elderly (RCFEs) to determine home health or hospice care eligibilities and make appropriate referrals.
• Maintains comprehensive working knowledge of Self-Help for the Elderly’s resources and markets to address patient needs.
• Maintains comprehensive working knowledge and assists the management team with monitoring, implementing, and evaluating the process, programs, and clinical policies to meet regulatory, accreditation, and community standards of Home Health and Hospice Care practice.
• Performs other duties and activities as assigned.

The above statements are only meant to be a representative summary of the major duties and responsibilities performed by incumbents of this job. The incumbents may be requested to perform job-related tasks other than those stated in this description.