Utilization (Quality) Review RN - Full Time
Partners in Home Care is hiring! Come work with Missoula's premier home health employer.
Partners in Home Care is a nationally accredited non-profit organization that has been providing quality home health care services to patients and families throughout Western Montana since 1987. We are passionately committed to assisting patients and families in achieving optimal health, independence, and comfort through high quality, cost-effective home and community health-related services.
We offer the following benefits to our employees:
Medical, Dental, Vision, and Life Insurance (that's affordable!)
Extensive Paid Leave (including paid holidays!)
401K with Company Match
Continuing Education Stipend
POSITION: RN - Utilization Review
LOCATION: Missoula, MT
STATUS: Full Time (FTE 1.0), Exempt (salaried - not eligible for overtime).
SCHEDULE: M-F, 8-5
This position reviews, plans and evaluates the care of agency patients in accordance with organizational policies and the standards of professional clinical practice within the framework of Home Health Outcome-Based Quality Improvement parameters, hospice quality initiatives, home health and hospice regulatory standards, and professional practice. Utilizes specialized knowledge, judgment and nursing skill to assess data and develop Plans of Care that ensure efficient utilization of home/hospice care resources while meeting patient care goals and optimizing outcomes.
Essential Duties and Responsibilities:
- Provides direction in development of the Plan of Care at the Start of Care, at Recertification, and at any Resumption of Care for each patient. Utilizes pertinent medical history and OASIS and other quality data as foundation for care plan interventions and goals, and determines optimum utilization of services to ensure optimum outcome performance in collaboration with the home health/hospice clinician and attending physician.
- Coaches clinical staff on the consistency of OASIS and other quality assessment measures and Plan of Care interventions to ensure that patient visits are consistent with the clinical and functional deficits identified in the Plan of Care.
- Coordinates with Program Manager and Supervisors to perform regular clinician meetings to evaluate the effectiveness of current Plans of Care in achieving expected outcomes. Assists with revisions to Plans of Care in accordance with the changing needs of patients.
- Reviews chart documentation for evidence of skilled interventions at each visit, as well as progression of the Plan of Care.
- Participates in the orientation and on-going education of PHC personnel related to documentation completeness, according to policies, procedures, and processes to meet and maintain compliance with ACHC accreditation standards.
- Performs clinical visits as needed to ensure appropriate implementation of patient plan of care.
- Performs clinical documentation reviews to improve PHC’s ratings in national quality indicators and outcomes, as assigned.
- Uses spreadsheets, databases and reports to track utilization trends.
- Performs other duties as assigned by supervisor.
Qualifications include a current RN license in the State of Montana (BSN preferred) with 3 years of previous RN experience and BLS certification. Requires high degree of attention to detail, computer aptitude, and proven proficiency with Microsoft Office applications and multiple clinical computer platforms. Prior experience in home care, insurance case management, or rehabilitative nursing preferred.
Job Status: Full Time
Job Reference #: 19157