QA Specialist (PRE-ID) (10828)

The Quality Assurance (QA) Nurse is a professional, registered nurse responsible for analyzing data integrity and consistency of OASIS documentation and assessment processes. This position will ensure appropriate ICD-9 coding and sequencing and will work with clinical staff to clarify documentation and data integrity issues. ESSENTIAL JOB FUNCTIONS/RESPONSIBILITIES

• Prospectively reviews all OASIS assessments to ensure appropriateness, completeness, and compliance with federal and state regulations and organization policy.
• Utilizes OASIS variation or alert reports when reviewing OASIS data.
• Ensures appropriate ICD-9 coding and sequencing as it relates to the patient's medical condition, including any co-morbidities.
• Consults with appropriate clinical staff to clarify any data integrity issues and works with clinician to make appropriate corrections per organization policy.
• Reviews visit utilization for appropriateness of care guidelines and patient condition; reports potential financial losses and/or underutilization to the clinical manager/designee.
• Notifies organization leadership of problematic trends as a result of OASIS review.
• Works with managers to address trends that affect the agency's outcome and process measures noted during OASIS review.
• Makes OASIS inter-rater reliability visits with clinical staff.
• Participates in Quality Improvement and Corporate Compliance activities as assigned.
• Assists with other chart audit activities as assigned.
• Maintains professional and technical knowledge by attending educational workshops and reviewing professional publications.

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.