Quality Review Specialist

Job Description

Job Description

About this position as a Quality Review Specialist

The Quality Review Specialists’ primary responsibility is to review HOPE documentation and Admission Documents for accuracy which will assist the agency in improving patient outcomes as reported by CMS and maximizing financial performance. The Hospice Clinical Reviewer’s reviews HOPE scoring and identifies variances and offers solutions to identified discrepancies. Provides support and education to clinical team on HOPE conventions. The Clinical Reviewer also reviews Admission and Discharge documents, i.e. Election of Hospice Benefit (EOB), Admission Service Agreement, Certificate(s) of Terminal Illness (CTI), Revocations, Transfer to Designated Hospice. The Hospice Clinical Reviewer’s reports and functions under the direct supervision of the Senior Director of Quality Review & Compliance. The position has a close working relationship with all clinical staff and leadership and Revenue Cycle Department to ensure that the clinical workflow is supported.

This is a hybrid position with the hours of 8 : 00am-4 : 30pm 40 hours per week and is eligible for benefits.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Reviews HOPE assessments ensure accuracy of data; Collaborates with assessing clinician to obtain accurate scoring for HOPE assessments
• Uses the Electronic Health Record (EHR) and external software, examples : SIMPLE, SHP, for HOPE review for inconsistencies, changes in outcome measures
• Reviews for accuracy on all Hospice admissions within the EHR including but not limited to : date of admission, certificate of terminal illness (CTI), HOPE item set, Election of Hospice Benefit (EOB), admission agreement, Plan of Care completed
• Enters Symptom Follow up Visit (SFV) in HOPE assessment as appropriate
• Reviews for accuracy on all HOPE Update Visit (HUV) assessments within the EHR including but not limited to : date of HUV completion, HOPE item set,
• Reviews for accuracy on all Hospice discharges within the EHR including but not limited to date of discharge, revocation documents, transfer to designated hospice documents.
• Completes HOPE Assessments in the EHR
• Pushes via the EHR, the hospice physician CTI after ensuring documentation is accurate in all relevant areas
• Completes Attending Physician CTI as applicable, ensuring documentation is accurate in all relevant areas.
• Scans and uploads admission documentation, i.e. EOB, Admission Service Agreement, Facility Level of Care, completed advanced directives, to the EHR
• Notifies nursing staff and clinical manager when admission documentation is inaccurate or incomplete
• Notifies clinical management timely with any staff non-compliance concerns and / or unfavorable trends identified.
• Utilizes decision support system and alerts clinical managers with potential issues.
• Participates in quality improvement projects as directed. Communicates effectively with agency personnel and all other customers in a timely manner.
• Consistently apply the HopeHealth values in all aspects of work, complying with established HopeHealth mission, policies, procedures and objectives in quality assurance, safety, environment, infection control and HIPAA compliance.
• Attains ongoing education for adherence with regulatory guidance changes
• Other duties as assigned.

Requirements to be a quality review specialist

CERTIFICATES, LICENSE, REGISTRATIONS

What are the job benefits?

For your health and peace of mind :

For your wellbeing :

For your career :

Discover a career that transforms lives – including yours.

At HopeHealth, health care is more than a career choice. It’s a calling.

You can see it in our incredible team, who are as compassionate as they are talented. You can see it in the trust that our patients and families place in us every day.

And you can see it in our values – as a health care organization, and as an employer. At HopeHealth, we care deeply about every life we touch, including yours. We’re committed to giving employees the support they need to not only excel at their jobs, but to love what they do.

Join us, and you’ll be part of a team that inspires you, a workplace that invests in you, and a mission that brings hope and dignity to patients and families every day.

HopeHealth is a not-for-profit market leader in the areas of palliative and hospice care serving Massachusetts and Rhode Island.

Our Hospice Care Team

HopeHealth’s hospice care team provides comfort and support to patients who are in the advanced stages of serious illness or nearing the end of life.

Join our team, and you’ll :

HopeHealth is an Equal Opportunity Employer

Our Commitment to Diversity, Equity and Inclusion

HopeHealth is committed to advancing diversity, equity and inclusion in the workspace. We believe that attracting, developing and empowering exceptional people will allow us to continue to deliver the best care for our patients and families.

All qualified individuals – inclusive of race, color, religion, sex, gender, sexual orientation, national origin, age and ability – are warmly welcome at HopeHealth.

8 : 00am-4 : 30pm

40