JOB SUMMARY:

• Responsible for the oversight, implementation, and coordination ofVNA Health at Home's Quality and Education Programs for Home Health Services
• Serves as the Agency's contact for Risk, Compliance, Privacy and Civil Rights complaints/grievances and reports to the Network's Compliance and Privacy Officer.
• Coordinates the process for all certifications, licensures and accreditations when necessary
• Coordinates and Implements Education, Competencies and Staff development programs/activities
• Develops and Maintains the Agency's Policy and Procedures
• Assists the Administrator in ensuring Agency compliance with State and Medicare regulations
• Performs all other duties that Management may determine necessary
• Reports to the Administrator

QUALIFICATIONS:

Minimum Education and Experience

• Must have a Bachelor's degree in Nursing or healthcare related field or equivalent healthcare industry experience
• Knowledge of Reimbursement including Medicare and Medicaid
• OASIS and/or Certificate for OASIS Specialist - Clinical
• Previous quality improvement related experience, including development and documentation of policy and procedures
• Knowledge of or experience with software applications in a Microsoft Windows environment including Word, Excel, Access and PowerPoint
• Knowledge of home health electronic medical record system

Other Qualifications

• Possess a valid Driver's License and personal vehicle
• Active Registered Nurse license in good standing in the State of Connecticut
• Knowledge of the fundamentals of Quality Improvement and education milieus
• Possess strong interpersonal skills to communicate effectively, make presentations and prepare concise written reports
• Quality orientation and high attention to detail
• Possess problem analysis and resolution skills
• Physical, mental, and sensory abilities sufficient to meet performance standards with or without assistive devices

PERFORMANCE CRITERIA:

The Performance Improvement Coordinator will possess the following skills and attributes and be responsible for the following duties:

1. Demonstrates clinical and organizational skills necessary to effectively manage and develop of the Quality Improvement Program.

• Coordinates, evaluates and monitors the implementation of all components of the Agency's Quality Improvement Program for Home Health Services
• Reviews Outcome Based Quality Improvement (OBQI) and Outcome Based Quality Measure (OBQM) reports in conjunction with the Clinical Management Team, completes outcome studies/follow ups.
• Monitors and coordinates the implementation of a corrective action plan for deficiencies identified through utilization review, clinical record review, Medicare claim denials, patient satisfaction surveys, State or Federal surveys, and the Performance Improvement Plan
• Implements quality improvement initiatives as specified in the Quality Improvement Plan

• Develops and implements educational programs for professional and para-professional staff in accordance with State and Federal regulations

• Critical review and timely submission of quarterly clinical record review, adverse event audits and surveys by regulatory agencies
• Ensures ongoing program planning and development

1. Demonstrates skills necessary as it relates to documentation, regulatory requirements and corporate compliance.

• Assists in the development and implementation of policies and procedures necessary to meet State and Federal regulatory and accreditation requirements
• Coordinates regulatory and accreditation activities and follows up to ensure compliance with assistance from other departments as necessary
• Provides direction toward achievement of goals and objectives related to data collection, summary of data, development and implementation of plan for improvement, evaluation and ongoing monitoring

• Coordinates and performs new staff orientation in accordance with State and Federal regulations

• Collaborates with clinical management staff and organizes annual clinical competency activities

• Develops and coordinates annual clinical competency activities
• Oversees and ensures overall coordination of the Agency's Compliance Program by establishing methods to improve the efficiency and quality of services and to reduce the Agency's vulnerability to fraud, abuse and waste
• Ensures the effectiveness of the Compliance Program through monitoring, evaluation and revisions to the program in response to changes in the laws, regulations, guidelines and standards
• Monitors and takes steps to ensure the agency's compliance with its civil rights and related regulatory obligations under state and federal law
• Addresses any civil rights complaints/grievances of VNA Health at Home patients under state and federal anti-discrimination provisions

1. Demonstrates organizational ability to coordinate and implement the Agency's Risk Management Program.

• Utilizes Agency clinical and patient perception of care, (patient satisfaction surveys) and outcome data to assess achievement of desirable outcomes for Agency patients
• Collaborates with departmental staff and other departments to obtain the data necessary to assess the quality of services being provided to patients
• Coordinates and implements the Agency's Infection Control Program
• Reviews and investigates all complaints and maintains accurate complaint logs
• Reviews all patient and employee occurrence reports
• Participates as a member of the Workplace Safety and Health Committee

1. Collaborates with the Director/Administrator and coordinates all activities related to the Professional

Advisory Committee, Quality Assurance and Improvement Committee, Workplace Safety and Health

Committee and any other quality performance improvement committee established.

• Reviews and evaluates current quality improvement, performance improvement and utilization data for trends and/or problems and prepares summary report for review by the President/Administrator
• Prepares and presents Annual Quality Assurance Report/Program Evaluation and 120 Day Report to the Professional Advisory Committee
• Assists the Director/Administrator with other meetings/task forces as appropriate, both internal and external

1. Demonstrates the ability to advance and integrate quality assessment, quality improvement and clinical development strategies throughout all Agency programs.

Ancillary Duties:

1. Develops and maintains professional skills to meet position requirements.

1. Participates in own professional growth and development.
   1. Knowledge of Agency Policies and Procedures.
   2. Seeks appropriate supervision.
   3. Participates actively in self-appraisal and the formation of a plan of self-development.
   4. Demonstrates knowledge of Agency computer programs.

1. Performs other duties as necessary to support Agency programs.

1. Adheres to the Agency Corporate Compliance Plan and HIPAA Privacy Plan as per written agreement.

Waterbury Health considers applicants for employment without regard to, and does not discriminate on the basis of an individual's sex, race, color, religion, age, disability, status as a veteran, or national or ethnic origin; nor does Waterbury Health discriminate on the basis of sexual orientation or gender identity or expression.