Regulatory Quality Improvement Coordinator RN Hospice Multi-State

Benefits Benefits from Day One: Medical, Dental, Vision Insurance, Life Insurance, Disability Insurance Paid Time Off from Day One 403-B Retirement Plan 4 Weeks 100% Paid Parental Leave Career Development Whole Person Well-being Resources Mental Health Resources and Support Pet Benefits Location 601 E ALTAMONTE DR, ALTAMONTE SPRINGS, FL 32701 Schedule Full Time Days. Dayshift Monday‑Friday 8:00am‑5pm. Travel to IL, CO, GA, NC, KS and/or FL as required. Job Description Coordinates all phases of record request processing, including ADRs, RAC requests, and Medicaid audits. Develops and implements procedures and processes for record request management. Instructs medical, clinical, and administrative staff in record request audit and processing procedures. Coordinates with other departments to ensure adequate staff resources for timely audit and processing activities. Establishes needs and communicates these needs to department managers or directors. Prioritizes record processing to ensure submission deadlines are met. Coordinates all levels of appeals processes for denied claims. Coordinates with the Quality Service and Risk Coordinator to maintain tracking database integrity and provide reports to other departments. Coordinates all communications with regulatory agencies. Identifies employee educational needs related to regulatory scrutiny. Partners with the Education Department to develop and provide education related to regulatory scrutiny. Collects and analyzes data for application to the Quality Assessment and Performance Improvement (QAPI) process. Identifies performance improvement opportunities in clinical documentation related to regulatory scrutiny. Other duties as assigned. Knowledge, Skills, and Abilities Knowledge of nursing skills in the performance of duties in compliance with the legal and ethical parameters established and based on the level of education and certification attained by the employee. [Required] Knowledge of laws, regulations and standards applicable to the provision of hospice care and services, including but not limited to the Medicare Conditions of Participation, Medicaid regulations, Agency for Health Care Administration regulations and NHPCO Standards of Practice. [Required] Knowledge of clinical software systems (e.g., HomeWorks). [Required] Knowledge of basic to intermediate application of Microsoft Office Suite including Word, Excel, PowerPoint, Outlook and Access, as well as internet software. [Required] Knowledge of internet research methods. [Required] Ability to follow standard precaution guidelines for infection control, including when providing patient care. [Required] Education Bachelor's [Required] Field of Study In Nursing, Health Care, or related field is required. An equivalent combination of education and experience may be substituted at the discretion of the Administrator. Work Experience 5+ years of experience in the field of nursing is required. A minimum of 1 year of hospice experience is required. [Required] Experience related to performance improvement, quality assurance is preferred, Hospice and/or home health care management experience is preferred. [Preferred] Additional Information N/A Licenses and Certifications Registered Nurse (RN) [Required] Certified Hospice and Palliative Nurse (CHPN) [Preferred] Physical Requirements Physical Requirements: Pay Range $60,748.67 - $97,197.90 Equal Opportunity This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances. #J-18808-Ljbffr