Clinical Review Nurse (Monmouth County) - Hackensack Meridian Health

Our team members are the heart of what makes us better. At Hackensack Meridian Health we help our patients live better, healthier lives — and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are just the beginning. It’s also about how we support one another and how we show up for our community. Together, we keep getting better - advancing our mission to transform healthcare and serve as a leader of positive change.

At Hackensack Meridian Health at Home, we recognize our full- and part-time benefit eligible team members by offering a Total Rewards package including comprehensive Health Benefits, generous Paid Time Off, Travel Reimbursement as well as an investment in your future with a 401(k) match and Tuition Reimbursement. Per Diem team members are eligible to participate in Travel Reimbursement and may be eligible to receive a 401(k) match.  At www.TeamHMH.com,  you’ll find the information, resources and tools that will help you to be successful at HMH. From great benefits and innovative wellness programs, to robust learning and development opportunities, we continue to cultivate an exceptional work environment where you can do the kind of work that leads to fulfillment and professional growth.

Education, Knowledge, Skills and Abilities Required:

• Minimum of two years of Healthcare experience

Education, Knowledge, Skills and Abilities Preferred:

• BSN
• Home Care Experience

Licenses and Certifications Required:

• NJ State Professional Registered Nurse License.
• Certificate for Oasis Specialist (COS-C, COQS, HCS-O) must be obtained within six (6) months of hire.

Responsible for OASIS reviews and comprehensive Home Care assessments.  Work directly with team members to educate and support appropriate documentation for coding, OASIS and Hospice, and other clinical assessment tools as needed.

• Review every Medicare and Managed Medicare admission chart to determine that the coding the clinicians document is appropriate.  Perform clinical reviews utilizing the appropriate system.  Make coding changes in the system if inappropriate codes are identified.
• Review each Hospice assessment to assure each CTI, 485 and all diagnoses are consistently matched.  Perform chart reviews to determine if the documentation is appropriately/accurately completed per the patients' diagnosis, as well as per state, federal and The Joint Commission guidelines.
• Perform focused analysis of coding issues to assure that coding accurately reflects the patient's clinical condition.  Identify areas of concern through focused coding audits.  Report coding issues to the Director of the certified operation, Hospice Clinical Director, and the Nurse Manager for the appropriate operation.  Demonstrates the ability to work with team members regarding coding issues.  Demonstrate flexibility and resourcefulness when interacting with team members and medical staff in collecting information for accurate and timely coding.
• Review HIS to assure an accurate reflection of the patient's condition and to assure HIS is consistent with coding.  Review every admission chart to determine whether the HIS is completed appropriately/accurately per the patient's diagnosis, as well as per state, federal and The Joint Commission guidelines.
• Identify areas of concern through focused clinical audits.  Trend data obtained from reports and review results with managers.
• Identify areas for improvement for team members that have been identified with inconsistencies in documentation, or documentation that does not accurately reflect the patients' condition.  Work with team member's manager and/or Nurse Manager to develop a plan of action and follow up.
• Review all new admission charts to ensure all quality indicators are completed at the initial encounter with the patient or within the five (5) day comprehensive assessment period.
• Review SHP/Point of Care system on a daily basis.  Resolve data discrepancies/ variances.  Resolve all alerts.
• Work with Coding vendor to resolve coding questions
• Meet with the interdisciplinary team on a weekly basis to review all new admissions.  Ensure that all records have the correct diagnosis. Determine that the coding changes have been recorded if updated at a team meeting.
• Code and enter data timely to meet productivity standards.
• Other duties and/or projects as assigned.  Demonstrate flexibility with job responsibilities in all areas.
• Adheres to HMH's Organizational competencies and standards of behavior.
• Lifts a minimum of 10 lbs., pushes and pulls a minimum of 10 lbs. and stands a minimum of 2 hours a day.