Manages and supports quality and performance improvement by assisting staff to implement strategies that identify, prioritize, measure, and improve key clinical processes and outcomes
Reviews patient records to determine the complete, accurate, and timely documentation of all conditions that support home health/hospice care and treatment of the patient
Reviews and interprets patient records and compares against criteria to determine medical necessity and appropriateness of care
Consults with providers, management, and operations to ensure consistency within the application of clinical criteria
Utilizes clinical expertise for the review of medical records against appropriate criteria in conjunction with contract requirements
Maintains current knowledge of clinical indicators and compliance requirements
Manages tools to collect outcome data and provides regular feedback to individuals, managers, and leaders
Provides concurrent medical record review to assess documentation compliance
Facilitates recommended interventions
Reviews deficiencies in documentation with involved staff and facilitates corrective action
Participates in the ongoing development and implementation of an established performance improvement plan
Reviews orders for data entry, completeness, and appropriateness for admission to home health/hospice services
Promotes, obtains, and reviews appropriate documentation for any home health/hospice specific quality data

Clinical Record Reviewer, RN

Key skills