SC Works Health Care Jobs

Job Information

Spartanburg Regional Healthcare System Clinical Review Registered Nurse (RN) Hospice in Spartanburg, South Carolina

The Clinical Review RN is responsible for the review of admission and discharge data as assigned to ensure appropriateness, completeness, and compliance with state and federal regulations. Ensures appropriate Coding and sequencing as it relates to the patient's medical condition, including any co-morbidities and current guidelines. Consults with the appropriate clinician to clarify data integrity and documentation. Evaluates the accuracy of admission and discharge data at each time point to ensure the data is collected, encoded, and reflects the patient’s status at the time of the assessment, based on the clinician’s documentation. Provides ongoing Quality Reporting Program (QRP) and documentation education to clinicians as needed. Follows up with clinicians to ensure timeliness of admission and discharge data corrections. Reviews admission and discharge and Plan of Care data for accuracy, appropriateness, and congruency. Ensures the completion of all necessary documentation by all disciplines for the completion and transmission process based on state and federal regulation. Notifies management of trends noted in QRP documentation as a result of data review. Assists with billing audits and issues as needed. Participates in quality assessment performance improvement process. Performs other duties as assigned.

Minimum Requirements

  • Education Graduate of an approved nursing program

  • Experience One (1) year Home Health/Hospice experience or Quality experience

Required Licenses/Registrations/Certifications

  • Current license to practice as a Registered Nurse in South Carolina

Core Job Responsibilities

  • Reviews admission/discharge data and plan of care for appropriateness, completeness, and compliance with federal and state regulations

  • Submits Quality Reporting Data assessments based on federal and state regulation.

  • Evaluates the accuracy of Quality Reporting Data at each time point to ensure the data is collected, encoded, and reflects the patient’s status at the time of the assessment, based on the clinician’s documentation.

  • Performs review of admission/discharge assessments as assigned to ensure appropriateness, completeness and compliance with state and federal regulations

  • Consults with appropriate clinical staff to clarify any data integrity issues and works with clinician to make appropriate corrections

  • Works with Clinical Leadership to address trends that affect the agency’s outcome and process measure noted during clinical review

  • Train and function as a field RN clinician, as needed

  • Other duties as assigned

DirectEmployers