Registered Nurse, Quality Case Manager

This is a fully remote position, open to applicants in Missouri.

📋 Description

• Oversee the quality and clinical care provided to patients.

• Create personalized care plans that encourage self-care and enhance quality of life through effective resource management.

• Design, execute, monitor, track, and report on quality assurance projects and initiatives.

• Conduct chart reviews to verify appropriate service utilization, patient care, and adherence to regulatory standards.

• Stay informed about HIPAA, regulatory, and compliance matters.

• Utilize OASIS data and necessary documentation.

• Support staff in addressing and appealing service denials.

• Collaborate with staff concerning documentation, service utilization, and regulatory compliance issues.

• Identify and track problems and trends from reviews, reporting on in-service requirements.

• Keep supervisors and field staff updated on trends observed from chart reviews.

• Engage in public relations initiatives and community involvement.

• Attend staff meetings and serve on assigned committees.

• Contribute to the performance improvement program.

• Develop, review, update, and implement the annual Quality Improvement Plan; monitor and report quarterly progress.

• Coordinate quarterly peer reviews.

• Prepare summaries of Quality Indicator findings along with recommendations for the Governing Body and staff.

• Provide orientation, education, and guidance to new employees, students, and home care aides.

• Instruct staff on documentation protocols and performance improvement strategies.

• Ensure the quality of documentation, regulatory compliance, service utilization, and timely, complete OASIS assessments and visit documentation.

• Educate staff about HIPAA regulations and report any instances of non-compliance.

• Complete mandatory annual in-services and maintain current CPR certification.

• Provide direct patient care as necessary in accordance with the nursing practice act.

• Assist other staff members with their assigned responsibilities.

⛳️ Requirements

• Candidates must reside within 50 miles of Saint Louis, Missouri.

• Graduation from an accredited nursing school is required.

• Must hold a current nursing license in the State of Missouri.

• Current registration as a nurse in the state(s) where practicing is essential.

• Preferred two years of experience in home health management.

• Strong knowledge of Medicare reimbursement policies and other third-party payers is desirable.

• Excellent interpersonal and communication abilities are necessary.

• Must possess a current state-issued driver’s license.

• Must have current motor vehicle insurance coverage.

• Vehicle should be in good working condition.

• Ability to participate in physical activities is required.

• Ability to stand for extended periods and engage in physical activities is essential.

• Capacity for frequent bending, lifting, and standing is necessary.

• Current CPR certification is required.

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Vision coverage.

• 401K plan with a 4% match.

• Paid Time Off.

• Life insurance.

• Short-term disability coverage.

• Accidental Death and Dismemberment insurance.

• Critical illness coverage.

• Hospital indemnity insurance.