Clinical Record Reviewer - RN - Home Health Remote

LV Home Care And Hospice Clinical Record Reviewer - Full-Time Days (Remote)

Imagine a career at one of the nation's most advanced health networks. Be part of an exceptional health care experience. Join the inspired, passionate team at Lehigh Valley Health Network, a nationally recognized, forward-thinking organization offering plenty of opportunity to do great work. LVHN has been ranked among the "Best Hospitals" by U.S. News & World Report for 23 consecutive years. We're a Magnet(tm) Hospital, having been honored five times with the American Nurses Credentialing Center's prestigious distinction for nursing excellence and quality patient outcomes in our Lehigh Valley region. Finally, Lehigh Valley Hospital - Cedar Crest, Lehigh Valley Hospital - Muhlenberg, Lehigh Valley Hospital- Hazleton, and Lehigh Valley Hospital - Pocono each received an 'A' grade on the Hospital Safety Grade from The Leapfrog Group in 2020, the highest grade in patient safety. These recognitions highlight LVHN's commitment to teamwork, compassion, and technology with an unrelenting focus on delivering the best health care possible every day.

Whether you're considering your next career move or your first, you should consider Lehigh Valley Health Network.

Job Summary

Manages and supports quality and performance improvement by assisting staff to implement strategies that identify, prioritize, measure, and improve key clinical processes and outcomes. Reviews patient records to determine the complete, accurate, and timely documentation of all conditions that support home health/hospice care and treatment of the patient.

Job Duties

Reviews and interprets patient records and compares against criteria to determine medical necessity and appropriateness of care. Consults with providers, management, and operations to ensure consistency within the application of clinical criteria. Utilizes clinical expertise for the review of medical records against appropriate criteria in conjunction with contract requirements. Maintains current knowledge of clinical indicators and compliance requirements. Manages tools to collect outcome data and provides regular feedback to individuals, managers, and leaders. Provides concurrent medical record review to assess documentation compliance. Facilitates recommended interventions. Reviews deficiencies in documentation with involved staff and facilitates corrective action. Participates in the ongoing development and implementation of an established performance improvement plan. Reviews orders for data entry, completeness, and appropriateness for admission to home health/hospice services. Promotes, obtains, and reviews appropriate documentation for any home health/hospice specific quality data.

Minimum Qualifications

Associate's Degree in Nursing. 2 years Experience as a Registered Nurse. Ability to work cross functionally across remote teams. Demonstrates a working knowledge of Medicare guidelines for hospice coverage. Demonstrated track record of continuous quality improvement. Proficient in prioritizing work and delegating where indicated. HCS-D - Home Care Coding Specialist-Diagnosis - Board of Medical Specialty Coding and Compliance Within 1 Year or HCS-O - Home Care Clinical Spec-OASIS - Board of Medical Specialty Coding and Compliance Within 1 Year or COS-C - Certificate OASIS Specialist-Clinical - OASIS Certificate & Competency Board Within 1 Year and RN - Licensed Registered Nurse_PA - State of Pennsylvania Upon Hire

Preferred Qualifications

Bachelor's Degree in Nursing. 2 years Hospice experience and 1 year Hospice documentation experience or 2 years Home Care experience and 1 year Home Health OASIS documentation or 1 year ICD-9/ICD-10 coding experience HCS-D - Home Care Coding Specialist-Diagnosis - Board of Medical Specialty Coding and Compliance Upon Hire or HCS-O - Home Care Clinical Spec-OASIS - Board of Medical Specialty Coding and Compliance Upon Hire or COS-C - Certificate OASIS Specialist-Clinical - OASIS Certificate & Competency Board Upon Hire

Physical Demands

Lift and carry 25 lbs. frequent sitting/standing, frequent keyboard use, *patient care providers may be required to perform activities specific to their role including kneeling, bending, squatting and performing CPR.

Lehigh Valley Health Network is an equal opportunity employer. In accordance with, and where applicable, in addition to federal, state and local employment regulations, Lehigh Valley Health Network will provide employment opportunities to all persons without regard to race, color, religion, sex, age, national origin, sexual orientation, gender identity, disability or other such protected classes as may be defined by law. All personnel actions and programs will adhere to this policy. Personnel actions and programs include, but are not limited to recruitment, selection, hiring, transfers, promotions, terminations, compensation, benefits, educational programs and/or social activities.