Job Description
This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more.
Role Description
- This role is responsible for leading agency wide quality, compliance, and utilization management initiatives. Key responsibilities include:
- Provide leadership and oversight for Quality Assurance, Performance Improvement (QAPI), and Utilization Review programs for home health and hospice
- Ensure compliance with CMS Conditions of Participation, state regulations, accreditation standards, and payer requirements
- Oversee utilization review processes to ensure medical necessity, appropriate level of care, and regulatory compliance
- Lead survey readiness efforts and serve as a key resource during state, CMS, and accreditation surveys
- Analyze quality data, outcomes, denials, trends, and audit findings, develop corrective action plans and monitor effectiveness
- Collaborate with clinical leadership to improve documentation quality, care planning, and interdisciplinary coordination
- Provide guidance and oversight related to OASIS accuracy, hospice eligibility, and regulatory documentation standards
- Develop, implement, and maintain QA/UR policies, procedures, and education programs
- Support coding, billing, and reimbursement integrity initiatives
- Stay current on regulatory changes impacting home health and hospice and proactively implement organizational responses
- Qualifications
- Active WA State RN License
- Minimum of 5-7 years experience in home health and/or hospice quality, compliance, or utilization review
- Strong working knowledge of CMS regulations, COPs, QAPI, OASIS, PDGM, hospice eligibility, and utilization management
- Experience with survey management, audits, corrective action plans and regulatory investigations
- Demonstrated ability to analyze data, identify risk, and drive performance improvement
- Excellent communication, leadership, and stakeholder engagement skills
- Requirements
- Home Health Hospice quality assurance/utilization review: 5 years (Preferred)
- WA State RN License REQUIRED
- Benefits
- 401(k)
- Competitive salary
- Dental insurance
- Employee assistance program
- Flexible schedule
- Health insurance
- Life insurance
- Paid time off
- Professional development assistance
- Vision insurance
Company Description
Flexible work from home options available.
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