Why consider applying to Visiting Nurse & Health Services of CT? Here are a few reasons: 

- Small territories and manageable caseloads for a better work-life balance.

- Flexible schedules to accommodate your needs. 

- Front loaded paid vacation time with 26 days offered if you work 40 hours a week, otherwise prorated. 

- Tuition reimbursement to help you continue your education and career growth. 

- Medical/Dental/Vision/Voluntary Benefits/STD and more

- Free parking and discounts offered through Perk Spots at local retailers, restaurants, and child care centers. 

 

Join our team and enjoy these benefits while providing quality care to our patients. Apply now! 

POSITION SUMMARY:

The Quality Manager will work with the Administrator to coordinate department activities.  Supports the department’s efforts to audit, track and trend patient outcomes, analyzes data, develops and implements targeted programs and initiatives for improvement in areas identified such as correct coding and documentation initiatives, infection control program and records management.  Quality Manager monitors all data for improvement in areas of need.  Responsible to collect data for quarterly performance improvement initiatives, performs concurrent audits for compliance with state regulations and assists in progressive appeals in Medicare Claims appeals as well as documentation requests for determination of medical necessity.  Quality Manager coordinates with Clinical Educator, for orientation, training, and development of Agency staff related to QAPI plan and initiatives.  Quality manager supervises Clinical Documentation Specialists as well as Clinical Support Specialists.

EDUCATION/CERTIFICATION:

RN degree in Nursing from an NLN approved school or Registered Physical Therapist preferably with master’s or doctorate degree.  Possession of a current license to practice as a registered nurse or as a Physical Therapist, or Occupational Therapist in the state of Connecticut.

EXPERIENCE:

Four (4) years full-time clinical nursing, Physical therapy, or Occupational therapy experience, at least two of which were in a home health agency. Experience in Quality Assurance and Performance Improvement activities or other similar change implementation preferred.

KNOWLEDGE/SKILLS/REQUIREMENTS:

Knowledge of Community Health and Home Care Principles.  Knowledge of Agency Policy and Procedures.  In-depth knowledge of Medicare criteria.  Knowledge of reimbursement criteria.  Knowledge of and ability to apply and remain in compliance with accreditation and licensure regulations.  Excellent interpersonal relations skills, oral and written communication skills, and organizational skills.  Excellent negotiating skills and problem-solving skills.  Possess adequate transportation to carry out job requirements.  Must show proof of satisfactory automobile insurance with minimum coverage per Agency policy for bodily injury and property damage when using automobile for transportation.

ESSENTIAL DUTIES and RESPONSIBILITIES:
Disclaimer: Job descriptions are not intended, nor should they be construed to be, exhaustive lists of all responsibilities, skills, efforts or working conditions associated with the job.  They are intended to be accurate reflections of the principal duties and responsibilities of this position.  These responsibilities and competencies listed below may change from time to time.  Eastern Connecticut Health Network reserves the right to change or assign other duties and responsibilities to this position.

Directly manages and supports the Quality Assurance program to meet Agency standards, licensure regulations and federal and state regulatory requirements which include the following activities: Manages all members of the quality department including two clinical documentation specialists and two clinical support specialists. Critical review and timely submission of quarterly process and outcome data for Quality Improvement. Critical review and timely submission of adverse events data for Quality Management. Works with clinical managers, program coordinators, clinicians, and others to compile and analyze performance improvement data from selected specialty areas. Performs concurrent review of records for various performance initiatives as part of agency QAPI program. Participates in Agency Orientation of all staff regarding the Quality Assurance and Performance Improvement Program and the role of the individual in the Quality Assurance and Performance Improvement Program. Assists in the management of payer and industry audits of claims and appeals process: Assists in the review of all Third-Party Payer audits that include but is not limited to Additional Documentation Requests (ADR), Recovery Audit Contractors (RAC), and Third-Party Liability (TPL). Responds to Focus Medical Review Requests. Assists in processing claims through Reconsideration and ALJ Appeals process. Participates in Corporate Compliance initiatives that includes but is not limited to the following: Monthly pre-billing audits for Medicare, Medicaid and Hospice payers. Clinical Documentation Improvement initiatives. Responsible for Agency’s infection control program: Conducts quarterly infection control audits of patient records. Tracks and trends the results of the infection control program. Evaluates the infection control program against national and regional standards and develops initiatives and program changes to ensure improved performance if needed. Coordinates the agency response to infection trends. Provides staff with education related to infection control and is a resource to the staff on topics related to infection control. Participates in Quality Improvement initiatives and functions: Identifies both positive and negative trends in OASIS, documentation and care planning. Participates in individual clinician education through one-on-one review and discussion. Participates in development and implementation of Quality Improvement activities and functions as needed. Facilitates and or participates in PI work groups on specific aspects of the PI plan. Supports clinical staff with CRR. Concurrent review of records to monitor progress of initiatives. Provides feedback to Clinical Educator and Clinical Managers to promote effective ongoing educational and staff mentoring: Identifies knowledge deficits in Agency clinical and management staff and assists with the quarterly education plan to address those knowledge gaps. Assists in developing instructional materials, as requested, to include plans, objectives, audiovisual aids, activities and evaluation plan tools related to knowledge deficits or quality initiatives. Advises clinicians and team leaders on staff performance improvement. Provides relevant feedback to Clinical Managers about staff performance as identified in audits related to documentation for quality, justification for services and reimbursement in accordance with Agency policy, regulatory and accreditation standards. Maintains knowledge of Best Practices and works with Clinical Systems Coordinator to identify Best Practice implementation. Serves on Agency committees as needed, that includes but is not limited to Quality Assurance Performance Improvement Committee and focus groups aimed at improving performance. Develops and maintains professional skills to meet position requirements. Participates in their own professional growth and development. Knowledge of Agency Policies and Procedures. Attends a minimum of 12 hours of in-services per year. Seeks appropriate supervision. Participates actively in self-appraisal and the formation of a plan of self-development. Demonstrates knowledge of Agency computer programs. Evaluation of staff performance per agency policy. Assures timely and accurate completion of all Agency Face to Face requirements. Assures that all orders obtained from Clinical Support Specialists are received timely and are complete. Counsels assigned staff appropriately and in a timely fashion concerning areas of deficiency as well as areas of excellence. Performs other duties as necessary to support Agency programs. Adheres to the Agency Corporate Compliance Plan and HIPAA Privacy Plan as per written agreement.