Duke Homecare & Hospice offers hospice, home health and infusion services. Hospice care is offered to terminally ill patients in their home, skilled-nursing facilities, assisted-living facilities, and at our two inpatient facilities located in Hillsborough and Durham, North Carolina.
General Description of the Job Class:
The Quality Assurance Analyst is responsible for performing professional administrative duties related to auditing, assessing, training and evaluating performance improvement and regulatory compliance activities of Duke HomeCare & Hospice (DHCH). In collaboration with the Director and with senior leadership, identifies, plans and executes activities, as well as designs/delivers staff education, to promote patient safety, clinical documentation, performance improvement initiatives and to ensure compliance according to regulatory statues, policies and procedures.
Duties and Responsibilities of this Level: Serves as liaison/resource to home care staff related to care/utilization. Conducts or arranges for educational opportunities for all home care staff related to clinical case management utilizing current managed care terminology and standards of practice to ensure the agency has a working knowledge and understanding of serving as a participating managed care provider, helps the staff to understand the paradigm shift and the resultant process change required to care for home care patients and communicate such under a managed care mindset. Approves plan of care after input from clinical staff. Plan of care approval to include appropriate discipline use, appropriate number of visits, and appropriate visits/plan goals. Innovative in determining alternative ways to provide health care services for clients. Coordinates and oversees the coordination of inter disciplinary Patient Care Conferences for home health patients to:
Support the development of and adherence to individual patient Plans of Care. Coordinate utilization management, and ensure that episode management is efficient and meaningful.
Facilitate discussion among the inter-disciplinary care team, reinforcing patient goal setting and related care planning.
Identify need for and recommend strategies or activities intended to improve performance in clinical quality, patient safety, and regulatory compliance of approved plans of care at time of admission and at Resumption of care (ROC) and Recertification.
Demonstrates a working knowledge and understanding of current managed care contracts, Medicare/Medicaid regulations related to covered services, HHRG, SHP data and the mission of Duke HomeCare & Hospice.
Identifies diagnosis in which agency would benefit if care map/clinical pathway was developed to effectively utilize resources.
Works effectively with designated hospital and home care staff to develop and implement clinical pathways and care maps that provide a continuum of care from inpatient to home care settings.
Analyzes balance of diagnoses and HHRG calculations on an ongoing basis to ensure financial success.
Demonstrates the ability to obtain and interpret information related to patient care needs understanding the range of treatment required for all ages and diagnostic groups. Recommend to and/or participate with DHCH leadership in development of annual performance improvement, quality assurance and regulatory compliance strategic plans for assigned programs of DHCH.
Participate in the development of, and recommend, BSC metrics and targets. Participate in Continuous Quality Improvement activities; identifies trends in utilization management which need addressing; submits data released to managed care and utilization management to quality assurance/improvement team indicating trends and recommendation for improvement.
May lead/direct teams at DHCH.
Maintain up to date knowledge of Medicare/Medicaid/JC/HIPPA regulations through in-services and workshop attendance.
Teach and train all staff on new regulations or changes in regulations/standards.
Assists in the development of DHCH policy, procedures and objectives.
Performs other duties as assigned.
Required Qualifications at this Level:
Education: Bachelor's degree in nursing (RN). Would consider RN graduated from an NLN approved Nursing School, licensed as an RN.
Experience: Minimum of 2 years home care experience with at minimum 1 year experience related to performance improvement, quality assurance or regulatory affairs.
Degrees, Licensures, Certifications: Appropriate certification/licensure as required by clinical field.
Knowledge, Skills, and Abilities: Working knowledge of Medicare and Medicaid regulations, JC and DHSR standards, and ICD-10 Coding. Maintains confidentiality of employee and patient information. Promotes quality, comprehensive services through a team approach. Excellent interpersonal communication and organizational skills required.
Duke is an Affirmative Action/Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, sexual orientation, or veteran status.
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