Clinical Quality Improvement and OASIS Nurse (RN) 

About the Role

Join our dynamic healthcare team as a Clinical Quality Improvement and Oasis Nurse (RN), where your expertise will drive excellence in patient care, clinical documentation, and healthcare compliance. In this vital role, you will leverage your nursing background and clinical knowledge to enhance quality initiatives, ensure adherence to healthcare regulations, and optimize documentation standards across diverse care settings. Your proactive approach will support continuous improvement efforts, elevate patient outcomes, and uphold the highest standards of healthcare delivery.

Duties

Conduct comprehensive reviews of medical records and clinical documentation to ensure accuracy, completeness, and compliance with CMS (Centers for Medicare and Medicaid Services) regulations, including ICD-10/ICD-9 coding standards.

Collaborate with interdisciplinary teams to facilitate utilization management, discharge planning, and case management activities across inpatient, outpatient, long-term care, and home care settings.

Utilize EMR/EHR systems such as Epic, Cerner, Athenahealth, or eClinicalWorks to extract data, perform documentation audits, and support clinical documentation improvement initiatives.

Perform detailed coding reviews using CPT (Current Procedural Terminology), DRG (Diagnosis-Related Group), ICD coding systems, and MDS (Minimum Data Set) assessments to ensure proper reimbursement and regulatory compliance.

Support quality improvement projects by analyzing clinical data trends, identifying gaps in care or documentation, and implementing corrective actions aligned with Medicare, CHAP and ACHC standards.

Assist in maintaining compliance with HIPAA privacy rules and state healthcare regulations while managing sensitive medical records and health information management tasks.

Provide education to clinical staff on documentation standards, physiology knowledge, medical terminology, and health regulation policies to foster a culture of continuous learning and quality excellence.

Will be making field visits.

Experience

Registered Nurse (RN) licensure with current state certification required; BSN required.

Proven experience in managed care environments with a strong understanding of Medicare, CHAP and ACHC regulations and utilization review processes.

Familiarity with EMR/EHR systems such as Home Healthcare EMRs, Epic, Cerner, Athenahealth, or eClinicalWorks; proficiency in Microsoft Office suite is essential.

Knowledge of medical coding including CPT, ICD-10/ICD-9/ICD coding systems; experience with DRG assignments is advantageous.

Prior involvement in clinical documentation improvement programs or health information management initiatives preferred.

Experience working within Home Health Agency, hospital or outpatient clinics with exposure to discharge planning, hospice care, or long-term care regulations enhances suitability for this role.

Strong understanding of healthcare policies related to CMS guidelines, HIPAA compliance, long-term care regulations, and Medicare requirements.

Embark on a rewarding career where your nursing skills make a tangible difference! We are committed to fostering an inclusive environment that supports professional growth while ensuring the highest quality of patient-centered care through meticulous documentation review and continuous quality improvement efforts.