Quality Improvement Coordinator

Demonstrates desired results in achievement of all relevant strategic, budgetary and operational targets and objectives including revenue, expense, utilization and quality indicators.

Works with clinical supervision to ensure that patient care meets established quality and utilization standards, and complies with federal, state, and local regulations

Compiles and analyzes data, prepares statistical reports related to quality and utilization issues as directed and makes recommendations for quality improvement activities.

Supports the performance of clinical teams through initiation and facilitation of quality improvement projects and staff education.

Reviews clinical documentation to ensure acceptable standards of clinical practice and reimbursement, as well as compliance with regulatory guidelines.

Reviews physician orders for technical and clinical accuracy and appropriateness.

Responds to queries and denials of payment (Medicare, Medicaid, BCBSM or other payers), and participates in audits and surveys as directed.

Recommends write-offs to the billing department or Finance Director.

Maintains current knowledge of all institutional, state and federal policies and regulations (Federal, MDCIS, Medicare, Medicaid, BCBSM) as it relates to the utilization of services and acts as a resource for department personnel in this area.

In conjunction with the clinical supervisors, participates in orientation of staff regarding Conditions of Participation, third party coverage and other insurance coverage issues and its proper documentation.

Monitors new staff utilization of services for a designated period of time to ensure appropriate utilization of services.

Provides regular audit reports regarding quality improvement, utilization, and compliance activities to the Quality Manager.

Keeps upper management, supervisors and staff knowledgeable regarding the state of utilization patterns within the department.

Assists in the planning, organization, implementation, evaluation and supervision of student training and provision of care and services.

Participates in development and ongoing review of the Quality Assurance and Performance Improvement program (QAPI). Ensures priority initiatives are addressed timely.

Participates in accreditation survey readiness activities and the survey process.

Participates in organization sponsored inservice training.

Patient and Family Centered Care

• Actively engages the patient, patient representative (if any), and family, as applicable, by exhibiting respect and dignity, sharing information in a timely and unbiased manner, and welcoming and encouraging participation to achieve shared decision making.
• Collaborates with other members of the team, including the patient, patient representative (if any), and family to achieve the ideal patient care experience.

Practices within the scope of license, certification, or registration.

Complies with all applicable continuing education requirements.

Complies with all University of Michigan and departmental standards and expectations.

Supports the department's commitment to lean thinking principles and to continuous improvement activities, and contributes positively and respectfully to all problem-solving and change processes at Home Care Services.

Performs other duties as assigned.

Current licensure as a Registered Nurse or Physical Therapist, or certification as an Occupational Therapist, in the State of Michigan

One year of experience in Medicare certified home health agency

Demonstrated knowledge of Medicare rules and regulations

Leadership and excellent communication skills

Ability to travel from point A to point B throughout the workday as assigned

Previous home health care Quality Improvement (QI) and/or Utilization Review (UR) experience

Bachelor's Degree in Nursing or Occupational Therapy, or Master's Degree in Physical Therapy