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Utilization Review Nurse Coordinator

Toledo, Ohio 000 - HCR ManorCare Corporate Office
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ProMedica is a mission-based, not-for-profit health and well-being organization headquartered in Toledo, Ohio. It serves communities in 26 states. The organization offers acute and ambulatory care, an insurance company with a dental plan, and post-acute and academic business lines. The organization has more than 49,000 employees, 12 hospitals, 2,500+ physicians and advanced practice providers with privileges, 1,000+ healthcare providers employed by ProMedica Physicians, a health plan, and senior care services.


ProMedica`s senior care division, formerly known as HCR ManorCare, operates 335+ assisted living facilities, skilled nursing centers, memory care communities and hospice and home health care agencies. Services are provided in 26 states and currently operate under the brand names Heartland, ManorCare, ProMedica and Arden Courts. Over the next 6 months, the senior care entities will continue to rebrand to ProMedica.


Driven by its Mission to improve your health and well-being, ProMedica has been nationally recognized for its advocacy programs and efforts to address and lead in social determinants of health, champion healthy aging and cultivate innovative solutions. For more information about ProMedica senior care services, please visit www.promedicaseniorcare.org.


Description

ProMedica Senior Care provides a range of services, including skilled nursing care, assisted living, post-acute medical and rehabilitation care, hospice care, home health care and rehabilitation therapy.

The Utilization Review Nurse Coordinator is responsible for prospective evaluation of home care documents.These documents include review of the OASIS assessment and care plan including physician ordered interventions to be provided and evaluation of documentation to support home care eligibility for reasonable and necessary services, homebound status and compliance with home health requirements and established policies under the supervision of the Director of Home Care Clinical Services

  • Prospective evaluation of admissions and re-certifications for completeness and compliance with established Medicare guidelines.
  • Evaluates the physician ordered Plan of Care (POC) and OASIS materials for accuracy of assessment, as well as, ensuring the documentation is appropriate based on patient diagnoses. Recommends changes to the physician ordered POC as needed.
  • Provides evaluation of episodic management for patient at assigned locations to ensure the ordered care provided will meet patient specific goals.
  • Evaluates and recommends edits to the OASIS assessment, as needed, prior to submission to the Centers of Medicare and Medicaid Services.
  • Coordinates with agency leadership and appropriate clinicians, as well as, physician offices and discharge planners to discuss ordered interventions and make recommendations regarding any patient care, coverage, eligibility and reimbursement issues. Solicits additional information necessary to complete the overall evaluation process.
  • Maintains current knowledge on regulatory changes that affect federal and state home health services.
  • Acts as a resource to all assigned agencies for coverage issues. Provides on-site education on the OASIS assessment, ICD-10 diagnosis coding, plan of care development including physician orders and other requested topics, in coordination with the Clinical Services Consultants (CSC).
  • Keeps agency leadership apprised of problem areas requiring intervention and identifies trends of findings from review for inclusion in the agency’s QAPI Plan.
  • Uses clinical expertise, judgment and discretion to foresee and advise the Director of Home Care Clinical Services on areas of potential concerns, including but not limited to: the assessment process; development of the plan of care; physician ordered interventions; and evaluations by agency supervisory staff.
  • Reviews and communicates data on a patient’s progress towards goal(s) for the purposes of advising agencies on how to interpret and manage the patient’s care plan based on that data.

Educational Requirements

Licensed Registered Nurse

Position Requirements

Education: Currently licensed as a RN, must obtain OASIS and ICD 10 home health certification within six months of hire

Experience: minimum 2 years of experience as a professional nurse, with an additional 2 years of home health provider or fiscal intermediary experience preferred. Knowledge of federal regulations and state licensure requirements

Category

Nursing - Management

Posting ID

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ProMedica Copyright © 2021 ProMedica Senior Care USA, Inc.
All Rights Reserved.

*Equal Opportunity Employer*

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