PIH Health is a nonprofit, regional healthcare network that serves approximately 3 million residents in the Los Angeles County, Orange County and San Gabriel Valley region. The fully integrated network is comprised of PIH Health Hospital - Whittier, PIH Health Hospital - Downey and PIH Health Good Samaritan Hospital, 27 outpatient medical locations, a multispecialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer, women's health, urgent care and emergency services. The organization is recognized by Watson Health as one of the nation's Top Hospitals, and College of Healthcare Information Management Executives (CHIME) as one of the nation's top hospital systems for best practices, cutting-edge advancements, quality of care and healthcare technology. PIH Health is certified as a Great Place to Work TM.
Performs comprehensive review of the Home Health and Hospice Prospective Payment System, including the Outcome and Assessment Information Set (OASIS), Home Health Plan of Care and Strategic Healthcare Programs (SHP) results, and Hospice Item Set (HIS) at the highest level of accuracy and productivity. Presents the findings and recommendations to the staff at all levels as well as senior management. Able to perform utilization review of the Electronic Health Record (EHR) for current and discharged patients.
The Quality Assurance/Utilization Review Registered Nurse (RN) will verify appropriate documentation, compliance, quality of care provided, ensure adherence to the plan of care, and identify document deficiency trends in a proactive approach. The Quality Assurance/Utilization Review RN will serve as a role model, consultant, auditor and OASIS/HIS expert to staff in PIH Health Home Health and Hospice auditing charts for clinical oversight and compliance and adherence to the Medicare guidelines. The Quality Assurance/Utilization Review RN is responsible for continuous assessment of agency processes to insure compliance with government regulations/accreditation standards, acts as a resource to the home care clinicians and the leadership team regarding standards, policies, and regulations.
- Knowledgeable about how to complete an accurate OASIS, Plan of Care and review SHP results
- Experience with OASIS Assessments, all related documentation and regulatory standards for documentation
- Demonstrated expertise in interdisciplinary Home Health care for patients of all ages, and in the clinical process (assessment, plan, implementation and evaluation)Familiarity with California State laws, regulations and standards governing Home Health care, including Community Health Accreditation Partner (CHAP) standards of excellence for Home Health, and with tools for evaluating Home Health care, including Medicare Conditions of Participation and Title 22
- Knowledge of EHR application
- Must have strong organizational and analytical skills
- Able to meet commitments and deadlines
- Must be proactive, detail-oriented, and able to work with minimal supervision
- Able to work well under pressure
- Demonstrated ability to coach and mentor new staff
- Excellent coordination and communication skills.
- Current California Registered Nurse license
- Bachelor of Science in Nursing
- One (1) year recent RN experience in home health
- Intermediate computer skills including Microsoft Outlook, Excel, Word, PowerPoint. Willingness to learn new information technology
- Current California State Driver's license and automobile insurance
- Master of Science in Nursing
- Experience in Quality Assurance and Utilization Review
- Experience with HIS assessments
- Previous coaching experience
- Working knowledge of OASIS and ICD-10 coding
- OASIS certification (COS-C)
- OASIS Home Health ICD-10 coding certification
For more information, visit PIHHealth.org or follow us on Facebook, Twitter, or Instagram.
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