Clinical Record Reviewer - RN - Home Health Remote

The Clinical Record Reviewer at Lehigh Valley Health Network manages and supports quality and performance improvement by reviewing patient records to ensure accurate documentation supporting home health/hospice care, working remotely in Pennsylvania.

Location: Remote in Pennsylvania

Responsibilities

• 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

Requirements

• 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