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Clinical Quality Assurance Manager Job Summary

The Clinical Quality Assurance Manager is responsible for performing on-going assessments of the home health agency based or state and federal regulations and agency policies and procedures. This person is responsible for QA audits daily, mainly for nursing, but therapy documentation may also be needed. Correct coding and auditing oversight for new admissions, transfer, discharge, or reassessment will be submitted to the 3rd party contracted company by the Clinical Quality Assurance Manager. The ideal candidate will have a minimum of 1-2 years of home health leadership experience and knowledge of PDGM guidelines.

Candidates must have prior leadership and supervisory experience in home health!

Reporting lines:

The Clinical Quality Assurance Manager will report directly to the Home Health Administrator.

Your direct reports:

• none

Clinical Quality Assurance Manager Job Functions include, but are not limited to:

• Directs and monitors quality improvement programs; continuously evaluates and improves processes, systems, and workflows. Evaluates systemic problems and develops action plans to address them.
• Reports results to superiors and subordinates, as appropriate.
• Complete complex quality reviews to determine if decision by review staff matches medical records and approved review methodologies.
• Monitors and analyzes Agency outcomes; strives for improvement through the QI process.
• Determine approval or initiate a referral to a physician consultant; review the rationales provided for your reference and future use.
• Communicates with the clinical managers/supervisors/staff on a regular basis to assure that documentation and care is accurate and reflective of client condition and meets Medicare guidelines.
• Involved in day-to-day patient care 50% of the time, including phone and in-person patient triage and patient education.
• Reviews and evaluates each case through a variety of means such as home visits, conferences, record review and the services provided by clinicians; discusses and verifies impressions, instructs, and guides clinicians to promote more effective performance and delivery of quality home care services; and is always available during operating hours to assist clinicians as appropriate.
• Effectively working with others offering leadership by example and being a team player.
• Conducts daily and weekly record reviews and communicates findings and recommendations to the Regional Director of Operations.
• Supports scheduling for home health care staff in partnership with other leaders or designated staff for nursing, therapy, and ancillary staff.
• Assists the Administrator and other supervisory personnel in the planning, implementation, and evaluation of in-service and continuing education programs.
• Supports the Administrator with the creation of Performance Improvement Plans based on daily audit reviews and other identified needs of the home health agency.
• Participates in interviewing, hiring, orientation, supervision, counseling, evaluations, and staff development as needed or assigned.
• Performs other duties and activities as delegated by the Regional Director of Operations and President of Long-Term Care and Home Health.

Minimum Qualifications:

· LPN with current licensure to practice professional nursing in the state.

· Previous experience in hospice, home care setting and with two years management or supervisory experience. Proven ability to work within an interdisciplinary setting.

· Complies with accepted professional standards and practice.

· Has excellent observation, time management, good judgment, and communication skills.

· Understands principles of pain/symptom management.

· Must be a licensed driver with an automobile that is insured in accordance with state and/or organization requirements and is in good working order.

· Complies and maintains current CPR certification.

· Demonstrates excellent observation, verbal, and written communication skills.

Preferred Qualifications:

• Strong work ethic, positive attitude, professional poise, and a self-starter.
• Substantial experience in managing complex and fast-moving projects with a proven history of reaching completion and achieving outcomes.
• Understanding of clinical workflows and an ability to interact face to face with clinical staff to document & analyze practice-specific workflows.
• Demonstrated ability to communicate ideas clearly and concisely, interface and present to leadership effectively.
• Promoting employee professionalism, ethical behavior, and personnel development.
• Excellent time management, organizational, and prioritization skills with the ability to balance multiple priorities. Strong analytical and problem-solving capabilities
• Maintain confidentiality of all PHI within guidelines of “need to know."
• Attention to detail and pride in delivering consistently accurate work.
• Strong passion for patient care and healthcare, with empathy for patients and frontline staff
• Excellent Microsoft Office capability (Outlook, Word, Excel)

Job Type: Full-time

Pay: From $29.00 per hour

Expected hours: No less than 40 per week

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Referral program
• Tuition reimbursement
• Vision insurance

Supplemental schedule:

• On call

Weekly schedule:

• Monday to Friday
• Weekends as needed

Education:

• Associate (Preferred)

Experience:

• Home Health: 1 year (Required)

License/Certification:

• LPN (Required)

Ability to Commute:

• New Madrid, MO 63869 (Required)

Ability to Relocate:

• New Madrid, MO 63869: Relocate before starting work (Required)

Willingness to travel:

• 50% (Required)

Work Location: In person