Claims Quality Audit Director jobs in Spartanburg, SC

The Director of Home Health Quality Management assumes the responsibility for planning, developing, directing, managing, and facilitating the Quality Programs of the Home Health Agency. Develops and monitors compliance with policies and procedures that address quality and patient safety. Discovers opportunities for improvement through data analysis and observation of processes of care, and through collaboration with internal and external resources and professional relationships. Lean/Six Sigma principles and other quality improvement tools are utilized to drive improvements that support strategic goals.  Ensures policies and procedures to comply with the federal, state and local laws, regulations, codes and current practice standards. Responsible for identification and assessment of compliance vulnerability and risk, assures compliance training and education for all levels of personnel, conducts and oversees audits of defined areas/functions to assess compliance, implements action/resolution to problems or misconduct. Maintains an environment of continuous survey readiness. Oversees the management and supervision of the home health Clinical Outcome Specialist and OASIS reviewers, Prepares and monitors the annual budget, develops staffing patterns, represents home health to the medical staff and assists with orientation of new associates for the agency. Serves as a resource to the program, and works collaboratively with the leadership team, mentoring managers and staff.  Responsible for the recruitment, retention, training, and continuing education of quality staff.  Responsible for reporting and validating data for regulatory compliance with OASIS, HHCAHPS and benchmarking initiatives. Ensures customer satisfaction, quality management and other activities as assigned.

Education         

• Bachelor’s Degree in Nursing or related clinical degree in healthcare

Experience        

• One (1) to two (2) years of healthcare experience in the post-acute service line and experience in quality/performance management

License/Registration/Certifications             

• Current license to practice as a Registered Nurse in South Carolina
• Valid SC Driver’s License with good driving record

Core Job Responsibilities

• Assist with the overall development and implementation of the Quality Assessment & Performance Improvement (QAPI) plan. Implement and report on activities and mechanisms for monitoring the quality of patient care.
• Assist in the identification of goals and related patient outcomes. Coordinate, participate, and report activities and outcomes results. 
• Develop quality improvement reports that include individual patient outcome information that is aggregated and is used to evaluate and improve the services provided by the agency.
• Assist leadership to achieve results through a process that considers agency context, describes desired performance, identifies gaps between desired and actual performance, identifies root causes, and selects interventions to close the gaps and measure changes in performance.
• Evaluate the adequacy of documentation of patient care services, based on established standards.
• Work collaboratively with agency leadership in evaluating outcomes reports and identifying areas needing improvement to provide guidance in developing
• Performance Improvement Projects. (Clinical and Administrative)
• Utilize standard processes to provide effective, efficient and safe delivery of home care services.
• Educate and involve associates in the Quality Assessment and Performance Improvement process.
• Monitor and evaluate compliance with agency standards, policies, and procedures – Compliance Officer
• Meet or exceed compliance requirements of regulatory bodies – Compliance Officer
• Track ongoing data and utilization of the data to identify areas for improvement and determine best practices.
• Perform assessment of processes that involve risks.  Review all variances, which may include incidents and accidents, for detection of trends, patterns of behavior, and for an action plan to decrease occurrences.