Want to work where team members are valued and treated like the most important asset of the company?Southland has been serving patients in the Southwest since 2009 and we have grown in to a highly respected provider of quality care. Our dedicated team of professionals takes great pride in delivering the highest quality of care to the patients who have entrusted us to serve them through our Home Health, Hospice and Geriatric Palliative Care divisions. As we continue to grow our operations throughout the Southwest, we are searching for team members to join us that will share that same passion for quality care.As an 'Employer of Choice', we create, foster and nurture a working environment that allows our team members to achieve high levels of success, personal fulfillment and growth in their career field.We want our team to be able to remain focused on the care of our patients, so we work hard to be focused on taking very good care of YOU! Our experienced, compassionate and dedicated leadership team serves with the focus of our patients receiving the best care possible from highly qualified, skilled and caring team of professionals. We offer competitive compensation DOE, Health, Dental, Vision, 401(K), PTO, Sick Days, Paid Holidays, Life and Supplemental insurance, employee referral bonus, training and education.We invite you to learn more about a career with Southland. Visit our web site at www.southlandhh.com to explore who we are, our passions, and our commitment to the patients and their families whom we serve. All new hires must pass a pre-employment drug screening, criminal background check and OIG screening.
Home Health experience required
Job Summary:The Quality Assurance Nurse reviews clinical cases that may be related to quality of care issues identified by appeals and grievance process, adverse events, which provides clinical interventions. This position requires participation in the health plan’s data collection as required by state regulation and accreditation. Create and maintain the ongoing design of quality of care studies or project plans that contain indicators based on sound clinical evidence/guidelines. Responsible for quality improvement aspects of risk adjustment processes, and data collection and review of PI interventions. As well as Oasis for SOC, DC and recertifications.Qualifications/Educational Experience:
Requires an RN with an unrestricted active license
Three years of clinical experience
Certified Professional in HealthCare Quality (CPHQ) preferred
Quality improvement managed care experience
Bachelor Degree preferred
Essential Duties and Responsibilities:
Review of clinical documentation and interpret data obtained from clinical records or systems to apply appropriate clinical criteria for quality of care complaints/grievances.
Coordinate the clinical resolution with internal/external clinician support as required. Maintain quarterly and annual reporting requirements per regulation and accreditation.
Assists the Quality Management Department with the coordination and preparation of medical record reviews, which includes ongoing review of medical records.
Participates in meetings with administrative and vendors for the medical record collection process. Works with internal workgroups to monitor accuracy of designated abstracted records.
Participates in all activities with vendors, consultants and auditors related to quality measures as mandated by regulatory bodies.
Quality improvement study design and implementation including selection of valid and reliable indicators, coordination of monitoring and evaluation activities, and medical record reviews. Analyze data and prepare concise, accurate and meaningful quality management reports in accordance with quality management principles. Provides data collection and report development support for quality improvement studies and performance improvement projects.
Educate members, providers, vendors/partners, and staff members on best practices. Development and implement innovative procedures to improve quality of work, quality of care, and quality outcomes and measures as mandated by regulatory bodies.
Assists with provider and member interventions and incentive efforts, as needed.
Assists as needed in support of state regulatory and accreditation activities
Works with the management team to identify any QI/PI issues