Regulatory Quality Improvement Coordinator RN Hospice Multi-State

Regulatory Quality Improvement Coordinator RN Hospice Multi-State

Joining AdventHealth is about being part of something bigger. It's about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.

Schedule: Full time

Shift: Day (United States of America)

Location: Supporting our teams in Multi-state program. Travel to any of our markets which include IL, CO, GA, NC, KS and/or FL.

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.
• 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.
• Knowledge of clinical software systems (e.g., HomeWorks).
• Knowledge of basic to intermediate application of Microsoft Office Suite including, Word, Excel, PowerPoint, Outlook and Access, as well as internet software.
• Knowledge of internet research methods.
• Ability to follow standard precaution guidelines for infection control, including when providing patient care.

Education:

Bachelor's 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+ experience in the field of nursing is required. A minimum of 1 year of hospice experience is required.

Licenses and Certifications:

Registered Nurse (RN) is required. Certified Hospice and Palliative Nurse (CHPN) is preferred.