Quality Assurance Registered Nurse (QA RN) Pavilion Medical Home Care & Staffing, LLC. - 2.6 Annandale, VA Job Details Full-time $95,000 - $105,000 a year 1 day ago Benefits Health insurance Dental insurance 401(k) Paid time off Qualifications Medicare Home health Home health agency experience Full Job Description Job Summary The Quality Assurance (QA) Registered Nurse is responsible for ensuring the accuracy, completeness, and regulatory compliance of clinical documentation for a Medicare-certified home health agency. This position reviews patient records, OASIS assessments, physician orders, care plans, and clinical documentation to ensure compliance with Medicare Conditions of Participation (CoPs), CMS regulations, state and federal guidelines, and agency policies. The QA RN serves as a clinical resource for field staff by providing education, identifying documentation deficiencies, and supporting continuous quality improvement initiatives. This role plays a critical part in maintaining survey readiness, reducing claim denials, improving patient outcomes, and supporting timely reimbursement. Essential Duties and Responsibilities Clinical Documentation Review Review all Start of Care (SOC), Resumption of Care (ROC), Recertification, Transfer, Discharge, Evaluation, and routine visit documentation for accuracy and completeness. Ensure documentation supports medical necessity and skilled services. Verify documentation meets Medicare and payer requirements. Review interdisciplinary documentation for consistency and accuracy. Ensure physician orders match the services provided. OASIS Review Perform comprehensive review of OASIS assessments before submission. Validate assessment accuracy and compliance with CMS guidelines. Review functional scoring, diagnoses, medication reconciliation, homebound status, risk assessments, and care planning. Return documentation to clinicians for correction when necessary. Collaborate with clinicians to resolve documentation discrepancies. Compliance & Regulatory Oversight Ensure compliance with: Medicare Conditions of Participation (CoPs) CMS regulations State licensing requirements HIPAA Privacy and Security Rules Agency policies and procedures Maintain current knowledge of Medicare regulations and home health standards. Monitor compliance with Medicare Conditions of Participation (CoPs), CMS regulations, and Virginia Department of Health (VDH) requirements. Maintain continuous CMS and VDH survey readiness by coordinating mock surveys, identifying deficiencies, and assisting with the development and implementation of Plans of Correction (POCs). Oversee Face-to-Face documentation, physician certifications, recertifications, and utilization review to ensure Medicare compliance. Prepare the agency for Additional Documentation Requests (ADR), Targeted Probe and Educate (TPE) reviews, and other regulatory audits. Quality Assurance Audits Conduct routine clinical chart audits. Monitor documentation timeliness and completeness. Audit physician orders and certification documents. Review medication profiles and care coordination documentation. Identify trends requiring corrective action. Collaborate with Coding and Billing to ensure clinical documentation supports PDGM reimbursement, minimizes claim denials, and meets Medicare billing requirements. Review documentation for coding accuracy and reimbursement readiness. Quality Improvement (QAPI) Participate in the agency's Quality Assurance Performance Improvement (QAPI) program. Analyze quality metrics and clinical outcomes. Assist with performance improvement initiatives. Recommend workflow and documentation improvements. Track quality indicators and compliance measures. Participate as a leader in the agency's Quality Assurance Performance Improvement (QAPI) program through monthly quality reporting, data analysis, and performance improvement initiatives. Monitor Home Health Value-Based Purchasing (HHVBP) and Home Health Quality Reporting Program (HHQRP) quality measures and recommend strategies to improve agency performance and patient outcomes. Survey Readiness Maintain agency readiness for state and federal surveys. Conduct pre-survey chart reviews. Identify and correct deficiencies before audits. Assist leadership during regulatory surveys. Coordinate mock CMS and VDH surveys to assess organizational compliance and identify opportunities for improvement. Develop, monitor, and follow up on corrective action plans and Plans of Correction (POCs) resulting from audits and regulatory surveys. Clinical Education Provide ongoing education to nurses and therapists regarding documentation requirements. Train clinicians on OASIS documentation and Medicare regulations. Coach staff on improving documentation quality. Develop educational resources to improve compliance. Provide ongoing clinician education regarding Medicare documentation standards, OASIS accuracy, PDGM requirements, and regulatory updates. Develop and implement competency assessments, documentation coaching, and individualized education plans to improve clinical quality and compliance. Physician Orders Review and verify physician orders for completeness. Ensure orders are signed and implemented timely. Monitor outstanding physician orders. Coordinate with physicians regarding documentation corrections. Incident & Risk Management Review incident reports involving: Falls Medication errors Hospitalizations Adverse events Patient complaints Participate in investigations and corrective action planning. Qualifications Minimum of 3-5 years of Medicare Home Health experience. At least 2 years of

QA/OASIS

review experience. OASIS expertise with strong knowledge of ICD-10 coding. COS-C and/or HCS-D certification preferred. Experience with PDGM reimbursement methodology and Home Health Value-Based Purchasing preferred.

Pay:

$95,000.00 - $105,000.00 per year

Benefits:

401(k) Dental insurance Health insurance Paid time off

Work Location:

In person