Core Roles and Responsibilities: Abstracts clinical information from OASIS as well as a variety of medical records, charts, and documents. Assigns appropriate ICD-10 diagnoses codes to patient records according to established procedures. Suggests changes to OASIS based on clinical documentation and recommends changes to the clinicians based on clinical documentation. Works with coding databases and confirms HHRG assignments. Management of the clinical care services of the assigned team.

Essential Functions:

1. Ensures quality and safe delivery of home health care services.
2. Establishes and monitors staffing patterns which reflects the productivity of skilled and non-skilled personnel.
3. Coordinates and supervises the quality of care rendered by CareGivers, Inc. clinical and auxiliary staff.
4. Acts as an intermediary between the agency and MD offices, hospitals, and other external agencies to handle client problems, accept MD orders, take referrals, and follow up as needed.
5. Assigns RN/ Physical Therapist/, Speech Therapist to do initial assessment as needed.
6. Establish method for coordination of care by all disciplines.
7. Oversees staffing patterns, missed visits and all functions related to scheduling.
8. Monitors overtime, inappropriate staffing and redlines, etc.
9. Reviews all authorization for care, to ensure proper routing and utilization of units prescribed.
10. Participate in the selection and orientation of new personnel.
11. Maintain current knowledge of healthcare services provided in the home environment. Maintain current knowledge of Medicare, Medicaid, insurance, and pre-authorization processes.

Qualifications and Experience: Graduate of an accredited school of professional nursing and BSN preferred. Two years of utilization of home health OASIS review experience, Five years experience in home health and/or hospice preferred. Certification in home health coding (HCS-D or BCHH-C in ICD-10), Certification in OASIS (COS-C or HCS-O). Experience in quality assurance (QA) or case management a plus.