What are the responsibilities and job description for the Quality Coordinator position at UpstreamManagement?
Position Purpose
The Quality Coordinator is a clinically licensed hands-on leader responsible for performing and managing quality, compliance, and performance activities for Home Health and Hospice services. They will work in close collaboration with the Healthcare Compliance Officer, Director of Clinical Services, and Director of Hospice. This role directly conducts audits, analyzes quality outcomes, leads and completes Performance Improvement Projects (PIPs), ensures OASIS and HOPE accuracy, manages iQIES submissions, and provides education to clinical staff.
The Quality Coordinator actively drives regulatory compliance, clinical documentation excellence, quality patient care, and optimal reimbursement through daily involvement in data review, staff coaching and education, and continuous quality improvement initiatives. This position requires a strong clinical background, expert knowledge of Home Health and Hospice regulations, and the ability to independently execute quality and compliance functions.
Required
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to use hands to finger, to handle or feel, and talk or hear. The employee frequently is required to stand; walk; reach with hands and arms; and stoop, kneel, crouch, or crawl. The employee is occasionally required to sit. The employee must occasionally lift and/or move over 100 pounds. Specific vision abilities required by this job include close vision, color vision, peripheral vision, depth perception, and ability to adjust focus.
Working Conditions
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.
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The Quality Coordinator is a clinically licensed hands-on leader responsible for performing and managing quality, compliance, and performance activities for Home Health and Hospice services. They will work in close collaboration with the Healthcare Compliance Officer, Director of Clinical Services, and Director of Hospice. This role directly conducts audits, analyzes quality outcomes, leads and completes Performance Improvement Projects (PIPs), ensures OASIS and HOPE accuracy, manages iQIES submissions, and provides education to clinical staff.
The Quality Coordinator actively drives regulatory compliance, clinical documentation excellence, quality patient care, and optimal reimbursement through daily involvement in data review, staff coaching and education, and continuous quality improvement initiatives. This position requires a strong clinical background, expert knowledge of Home Health and Hospice regulations, and the ability to independently execute quality and compliance functions.
- Develop, implement, and maintain the agency’s Quality Assessment and Performance Improvement (QAPI) program for Home Health and Hospice
- Directly interpret and apply CMS Conditions of Participation (CoPs), state regulations, payer requirements, and accreditation standards into daily operations
- Maintain policies, procedures, and workflows related to quality and compliance
- Personally monitor regulatory and CMS updates and integrate changes into policies, workflows, auditing tools, and education materials
- Serve as a primary individual responsible for survey readiness, survey response, and corrective action implementation
- Personally conduct routine and focused audits of:
- Clinical documentation
- OASIS and HOPE assessments
- Hospice eligibility and compliance
- High-risk and high-denial areas
- Document audit findings, identify trends, and complete detailed corrective action plans
- Provide direct, individualized feedback and education to clinicians based on audit results
- Review denial patterns and audit results and directly implement process improvements to support compliance and reimbursement
- Collect, analyze, and interpret quality outcomes data, including, but not limited to:
- Star ratings
- HHCAHPS/CAHPS
- Hospice quality measures
- Patient outcome indicators
- Prepare quality reports and summaries for leadership, governing body, and regulatory purposes
- Identify gaps in performance and directly implement strategies to improve documentation, outcomes and patient care
- Track effectiveness of interventions and adjust actions based on outcome data
- Design, implement, manage, and evaluate Performance Improvement Projects
- Collect and analyze PIP data, document findings, and maintain compliance with CMS QAPI standards
- Implement corrective actions and sustain improvements through ongoing monitoring
- Maintain required documentation to demonstrate regulatory compliance and measurability
- Review, validate, and correct OASIS assessments for accuracy, timeliness, and regulatory compliance
- Complete oversight and hands-on management of iQIES submissions, reconciliation, and error resolution
- Directly support and validate clinician completion of the Hospice Outcomes & Patient Evaluation (HOPE) tool
- Track submission errors, trends, and retraining needs and address them through direct education and process improvement
- Develop and deliver ongoing education related to:
- Regulatory compliance
- Clinical documentation standards
- OASIS accuracy
- HOPE tool requirements
- Quality outcomes and reimbursement impact
- Provide one-on-one coaching and remediation for clinicians as needed
- Participate directly in onboarding and competency training related to quality and compliance
- Serve as a primary resource for clinical staff questions related to quality, documentation, and regulatory requirements
- Collaborate directly with clinical leadership, operations, and billing to resolve quality, compliance, and reimbursement concerns
- Participate in interdisciplinary meetings related to quality and patient safety
- Promote a culture of accountability, regulatory compliance, and continuous improvement through direct engagement and education
- Support leadership with recommendations related to quality improvement, risk reduction, and survey readiness
- Maintain detailed records of audits, education, corrective actions, and quality initiatives
- Other responsibilities as assigned.
Required
- Active clinical license
- Minimum of 1-2 years of clinical experience in Home Health and/or Hospice
- Demonstrated hands-on experience with auditing, quality analysis, and regulatory compliance
- Expert knowledge of:
- CMS Conditions of Participation
- Home Health and Hospice regulations
- OASIS, iQIES, and HOPE tool requirements
- QAPI and PIP processes
- Strong ability to independently manage multiple quality functions
- Excellent communication, organization and teaching skills
- Ability to work collaboratively within the interdisciplinary team
- Certification in Quality or Compliance (e.g., CPHQ, CHC)
- Experience preparing for and responding to CMS, state, or accreditation surveys
- Strong EMR and data reporting proficiency
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to use hands to finger, to handle or feel, and talk or hear. The employee frequently is required to stand; walk; reach with hands and arms; and stoop, kneel, crouch, or crawl. The employee is occasionally required to sit. The employee must occasionally lift and/or move over 100 pounds. Specific vision abilities required by this job include close vision, color vision, peripheral vision, depth perception, and ability to adjust focus.
Working Conditions
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.
- General office
- Patient Home (as needed)
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