Cardiac Cath Lab Nurse Reviewer - Quality | M-F

Phelps Health is a 2000-employee-strong hospital and healthcare system serving the heart of small-town Missouri.

No matter where you start with us, we’re committed to taking our team to the top. If you’re ready for the challenge of providing life-saving care or supporting those who do, read on to find your fit in the Phelps Health family.

General Summary

The Cardiac Cath Lab Nurse Reviewer (CCLNR) collects and submits reliable data to the NCDR program by performing high-quality clinical screening, data compilation, documentation and entry into the database of all eligible procedures, in both inpatient and outpatient settings, for Phelps Health. The CCLNR works closely with the members of the Department of Clinical Quality and Measurement to identify opportunities for clinical quality improvement and other special projects as may be identified.

Essential Duties and Responsibilities

Ensures the reliable, accurate and timely collection of data components for the program through effective utilization of the Electronic Medical Record (EMR).
Identifies cath lab patients for inclusion in the program registry through the application of strict program inclusion/exclusion criteria.
Demonstrates applicability of the methodology and the reliability of definitions utilized by reviewers within the program.
Identifies areas for streamlining and process improvement in the data collection and cardiac cath lab process.
Maintains compliance with federal, state and regulatory body laws and regulations.
Monitors other quality indicators and efficiency measures identified outside what is required for NCDR.

Education

Graduate of an accredited school of nursing required. Bachelor’s in Nursing preferred.

Work Experience

Three (3) years’ experience in inpatient cath lab nursing preferred. Quality improvement and patient safety knowledge is preferred.

Certification/License

Current RN license in the State of Missouri or Compact Licensure.

Mental/Physical Requirements

Considerable mental concentration for sustained periods of time with frequent interruptions. Light lifting (15 lbs.) required. Standing, sitting and walking required.

Working Conditions

Typical office conditions with noise and distractions. Possible eye strain or other discomfort from constant use of computer screens.

At Phelps Health, we think we have a better team, benefits, and opportunities for growth than anyone else around, and we invite you to see for yourself! Apply now to join us on our mission in health care.

Share this job

Related Jobs

Other

3 weeks ago

NURSE (CLINICAL/COMM-OCC HLTH)

Defense Health Agency (DHA) FT LEONARD WD, MO

Overview NURSE (CLINICAL/COMM-OCC HLTH) About the Position: This position is located at Fort Leonard Wood Army Community Hospital in Fort Leonard Wood, Missouri.This is a Direct Hire Solicitation.A recruitment or relocation incentive may be authorized.Salary negotiation may be available for those candidates who are new to Federal service. Fort Leonard Wood, Missouri is home of the U.S. Army Maneuver Support Center of Excellence, Army Chemical, Biological, Radiological, and Nuclear School, Army Engineer School, and U.S. Army Military Police School. Fort Leonard Wood trains and educates nearly 90 thousand troops a year. Surprisingly, the Fort also trains Marines, Airmen, Sailors, Coast Guardsmen and international students from allied nations. With more than 22,000 military members and their families, Ft Leonard Wood provides us with a diverse and well skilled population. Fort Leonard Wood, situated in the heart of the Ozark Mountains, is a sportsman’s paradise with some of the most beautiful scenery, hosting many large lakes, rivers, streams, and forests ideal for fishing and hunting. Fort Leonard Wood covers more than 61,000 acres located in Pulaski County with a population of nearly 52,607. Bordering the installation to the north are the towns of Waynesville and St. Robert, with an estimated combined population of 9,170. The installation is situated between St Louis and Springfield, Missouri 1 ½ to 2 hours respectively. Also 30 minutes equidistant between Rolla and Lebanon along I-44. It is also a great place to raise a family along with a low cost of living. Working for the Department of Defense comes with an abundance of benefits and perks to include competitive compensation packages, paid-time off, medical benefits, student loan repayments, and retirement package with Thrift Savings Plan to include matching employer contributions. For more information, please visit the following link: https://www.usajobs.gov/Help/working-in-government/benefits/ Responsibilities MAJOR DUTIES: Provide a wide range of professional nursing and health care services, counseling, education and training to the military and civilian workforce. Assess impact of health status and test results on the ability of the patient to perform the essential functions of the job. Ensure pre-and post-medical monitoring is completed on all individuals required. Provide emergency care or crisis intervention including lifesaving emergency procedures in order to stabilize a patient for transport to the nearest Medical Treatment Facility (MTF) Perform medical surveillance health assessments for personnel exposed to hazardous agents. PERFORMS OTHER DUTIES AS ASSIGNED. Qualifications Who May Apply: US Citizens In order to qualify, you must meet the education and/or experience requirements described below. Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional; philanthropic; religious; spiritual; community; student; social). You will receive credit for all qualifying experience, including volunteer experience. Your resume must clearly describe your relevant experience; if qualifying based on education, your transcripts will be required as part of your application. Additional information about transcripts is in this document. Basic Requirement for Nurse (Clinical/Community-Occupational Health):Degree : A graduate or higher level degree, bachelor's degree, associate degree, or diploma from an accredited professional nursing educational program is required. This education must have been accredited by the Commission on Collegiate Nursing Education, Council on Accreditation of Nurse Anesthesia Educational Programs, Accreditation Commission for Midwifery Education, or an accrediting body recognized by the U.S. Department of Education at the time the degree was obtained. (Note: You must attach a copy of your transcripts.). Licensure : A current, active, full, and unrestricted license or registration as a professional nurse from a State, the District of Columbia, the Commonwealth of Puerto Rico, or a territory of the United States; and you must have passed the National Council Licensure Examination. Foreign Degree: A degree from a Foreign Nursing School. Official certification from the Commission on Graduates of Foreign Nursing Schools is required for individuals who graduated from foreign nursing schools. Exemption: You are exempt from the qualification requirements above if you are a current federal employee occupying a position in the 0610 occupational series and have been continuously employed in this occupational series since September 27, 2017 or before. Applicants claiming this exemption must meet one of the requirement below. Note: You will be required to provide appropriate documentation to the respective Human Resources Office to validate your status.Degree or diploma from a professional nursing program approved by the legally designated State accrediting agency at the time the program was completed by the applicant.Active, current registration as a professional nurse in a State, District of Columbia, the Commonwealth of Puerto Rico, or a territory of the United States. In addition to meeting the basic requirement above, to qualify for this position you must also meet the qualification requirements listed below: Education/Experience: A diploma, associate degree, or bachelor's degree in Nursing from a professional nursing program and possession of at least one full year of professional nursing experience (equivalent to the GS-9 grade level or above) which includes providing patient care, performing health assessments, and reviewing reports to identify occupational health hazards. OR Education : A PhD or equivalent doctoral degree from a professional nursing educational program or related medical science field including but not limited to Community Health or Occupational Health. EXEMPTION: You are exempt from the qualification requirements above if you are a current federal employee occupying a position in the 0610 occupational series and have been continuously employed in this occupational series since September 27, 2017 or before. Applicants claiming this exemption must meet one of the requirement below. Note: You will be required to provide appropriate documentation to the respective Human Resources Office to validate your status.Completion of all requirements for a doctoral degree (Ph.D. or equivalent) from a professional nursing programOR3 full years of progressively higher level graduate education from a professional nursing program Education FOREIGN EDUCATION: If you are using education completed in foreign colleges or universities to meet the qualification requirements, you must show the education credentials have been evaluated by a private organization that specializes in interpretation of foreign education programs and such education has been deemed equivalent to that gained in an accredited U.S. education program; or full credit has been given for the courses at a U.S. accredited college or university. For further information, visit: https://sites.ed.gov/international/recognition-of-foreign-qualifications/.

Other

3 months ago

NURSE (Clinical/Emergency Department)

Defense Health Agency (DHA) FT LEONARD WD, MO

Overview NURSE (Clinical/Emergency Department) Fort Leonard Wood, Missouri is home of the U.S. Army Maneuver Support Center of Excellence, Army Chemical, Biological, Radiological, and Nuclear School, Army Engineer School, and U.S. Army Military Police School. Fort Leonard Wood trains and educates nearly 90 thousand troops a year. Surprisingly, the Fort also trains Marines, Airmen, Sailors, Coast Guardsmen and international students from allied nations. With more than 22,000 military members and their families, Ft Leonard Wood provides us with a diverse and well skilled population. Fort Leonard Wood, situated in the heart of the Ozark Mountains, is a sportsman’s paradise with some of the most beautiful scenery, hosting many large lakes, rivers, streams, and forests ideal for fishing and hunting. Fort Leonard Wood covers more than 61,000 acres located in Pulaski County with a population of nearly 52,607. Bordering the installation to the north are the towns of Waynesville and St. Robert, with an estimated combined population of 9,170. The installation is situated between St Louis and Springfield, Missouri 1 ½ to 2 hours respectively. Also 30 minutes equidistant between Rolla and Lebanon along I-44. It is also a great place to raise a family along with a low cost of living. Working for the Department of Defense comes with an abundance of benefits and perks to include competitive compensation packages, paid-time off, medical benefits, student loan repayments, and retirement package with Thrift Savings Plan to include matching employer contributions. For more information, please visit the following link: https://www.usajobs.gov/Help/working-in-government/benefits/ Responsibilities MAJOR DUTIES: 1. Provides Emergency Department (ED) clinical nursing care to patients of any age group. Performs triage, while considering both physical and psychosocial elements. Must quickly assess incoming patients and prioritize patient care based on need, available staffing, and patient acuity. Works as part of a team in the ED and independently manages basic life support needs and stabilizes patients until the physician or provider is available, based upon professional nursing standards and protocol. Provides comprehensive nursing care to patients presenting for urgent or emergent care using knowledge of professional nursing theories, principles, and procedures; knowledge of clinical skills to provide specialized services to patients; knowledge of emergency and resuscitative measures; knowledge of triage; knowledge of pharmaceuticals sufficient to mix and administer special, potent, and potentially lethal drugs. Observes, monitors, and assesses patient's condition; recognizes, identifies, and interprets serious situations; determines and implements proper emergency measures; performs various pulmonary ventilation functions; operates and monitors highly complex technical equipment, (e.g. cardiac monitors, ventilators, various intravenous infusion pumps, and defibrillators) and documents appropriately in the health record. Independently reacts to emergencies, collaborates with physician, makes changes in nursing care plans, assesses patient's condition, and implements nursing care plans. Teaches, onboards, and mentors professional and paraprofessional nursing staff, assisting with complex nursing and diagnostic procedures. Responds to all emergencies during the shift. Responsible for advanced cardiac life support code team management until arrival of physician or provider. Team teaches advanced clinical skills and monitors junior nursing personnel multiple phases of instruction. Continuously observes for safety hazards ensuring immediate action to resolve/correct. Acts as facilitator to mediate complaints and concerns of patients, family members and staff, taking immediate action to resolve or refer to a higher authority. Interviews and takes medical histories, to acquire medically necessary information to assess physical and mental status of patient. Collects current symptoms, as well as a detailed patient history, and then consults and coordinates with health care team members to assess, plan, implement and evaluate patient care plans. Initiates patient education plan. Teaches patients and significant others how to manage their illness/injury, by explaining: subsequent inpatient plan, post-treatment home care needs, diet/nutrition/exercise programs, self-administration of medication and rehabilitation, as well as explanation of referrals to other healthcare professionals for follow-up treatment. Provides evidence-based instructions and education to patient/significant other and/or family members/caregivers. Performs adapted patient teaching with patients requiring special approaches or preferences and documents education provided. Serves as a resource person for nurses and other health care providers to consult when particularly difficult problems in the care of patients arise. Serves as role model to experienced emergency and other nurses as well as those who are not fully trained. Provides guidance and leadership to other professional nurses and paraprofessional personnel, assisting with complex nursing and diagnostic procedures. Provide orientation and on-the-job training for such personnel. 2. Manages the delivery of nursing care for weekend, holidays, training holidays and day/evening or night shifts using knowledge of an extensive range of professional nursing theories, principles, and procedures. Identifies and recommends strategies to improve nursing unit organization, functions. Manages the delivery of nursing care, utilizing knowledge of an extensive range of professional nursing theories, principles, and procedures. Functions as a charge nurse on a rotational bases and determines staffing requirements/mix and appropriateness of bed utilization based on analysis of patient acuity data; plans, delegates, and directs nursing care based on patient care requirements and staff skill levels; evaluates and modifies plan of care based on continuous assessment of patient needs and expected outcomes; collaborates with providers to facilitate the appropriate medical management of patients; and effectively directs patient care and unit activity. Consults with the supervisor and jointly shares in decisions; resolves most conflicts, and coordinates with other team members. 3. Conducts and participates in the development, implementation, coordination, and evaluation of facility, departmental, or unit-based programs. Continuously evaluates procedures/practices occurring in the emergency department to ensure quality patient care, recommending changes or implementation of nursing service policies and procedures when applicable. Recommends strategies to improve nursing unit organization and functions utilizing evidence-based practice (EBP). Work will influence policy and procedural documents in accordance with national standards, best practices, and emerging evidence. Identifies, implements and/or monitors quality and, process assurance/improvements, and EBP. Initiates action to improve the delivery of patient care; interprets and ensures compliance with established policies, procedures, and standards of care and practice; coordinates and collaborates with interdisciplinary team to develop strategies to improve services; etc. Participates in continuing education programs to update and/or maintain skills and knowledge to meet annual requirements. Participates in department and unit-level simulation/emergency drills, staff meetings, in-services/briefings, and in continuing quality and process improvement measures. Uses current research findings and other evidence to expand professional knowledge, enhance role performance, and increase knowledge of professional emergency nursing. Completes all training requirements designated by facility, supervisor, DHA, or accrediting agencies; participates in continuing education programs to update and/or maintain skills and knowledge to meet licensing requirements. PERFORMS OTHER DUTIES AS ASSIGNED. Qualifications Who May Apply: US Citizens Basic Requirement :Degree: A graduate or higher level degree, bachelor's degree, associate degree, or diploma from an accredited professional nursing educational program is required. This education must have been accredited by the Commission on Collegiate Nursing Education, Council on Accreditation of Nurse Anesthesia Educational Programs, Accreditation Commission for Midwifery Education, or an accrediting body recognized by the U.S. Department of Education at the time the degree was obtained. (Note: You must attach a copy of your transcripts.).Licensure: A current, active, full, and unrestricted license or registration as a professional nurse from a State, the District of Columbia, the Commonwealth of Puerto Rico, or a territory of the United States; and you must have passed the National Council Licensure Examination.Foreign Degree: A degree from a Foreign Nursing School. Official certification from the Commission on Graduates of Foreign Nursing Schools is required for individuals who graduated from foreign nursing schools.

Utilization Review

Full-time

3 weeks ago

RN - QUALITY REVIEW COORDINATOR

Freeman Health System MO

Our Mission To improve the health of the communities we serve through contemporary, innovative, quality healthcare solutions. Schedule : Monday - Friday (40hrs/week) About Us – Physician Reimbursement Center (PRC) Located inside the Freeman Business Center Vital part of our revenue cycle Our team consists of over eighty professionals that assure reimbursement for the valued services our clinicians provide What You’ll Do Performs a variety of duties in support of the quality assurance and compliance function of the Physician Reimbursement Center. Performs prospective chart reviews to ensure medical record accurately reflects the patient’s level of service, severity of illness and risk of mortality. Works closely with Medical Staff to clarify, assist and educate with documentation of evaluation and management coding. Requirements Minimum of 3 years of clinical experience in an acute care setting, (ICU, Medical/Surgical or Emergency Department nursing preferred). If homebound, must reside in one of the following states: Arkansas, Kansas, Missouri or Oklahoma. Current Missouri Registered Nurse license or current Registered Nurse license from a compact state. If a compact license is held, it must be in the nurse state of residence. Experience and skills in coding, billing and compliance. Preferred Requirements COSC Certification Freeman Perks and Programs For eligible full time and part time employees Freeman offers a wide variety of career opportunities, a great work culture and generous benefits, most starting day one! Health, vision, dental insurance Retirement with employer match Wellness program with discounts to Health Insurance or Cash Bonus with Participation Milestone payments with longevity of employment Paid Time Off (PTO) or Flex time off (FTO) Extended sick pay Learning Center designated only for Freeman Family members Payroll deduction at different locations such as The Daily Grind, Freeman Gift Shop, Cafeteria, etc

Utilization Review

Full-time

1 day ago

Clinical Coding and OASIS Review Specialist, RN, PT, OT, SLP

BAYADA Home Health Care Dallas, TX

$77,000 - $81,000 / year

Please note- Candidates must have COS-C, HCS-O or COQS and HCS-D or BCHH-C in order to be considered, there is no flexibility around this requirement. BAYADA Home Health Care has an immediate opening for a Full Time, OASIS and Coding Review Manager with OASIS and Coding certification to work remotely. RN, PT, OT, and SLP's with certifications will be considered for this role. BAYADA believes that our clients and their families deserve home health care delivered with compassion, excellence, and reliability. Apply your skills and knowledge of OASIS and ICD-10 coding to help clients receive the home health care services they need. BAYADA Perks: This is a fully remote position. Base Salary: $77,000 - $81,000 / year BAYADA offers a comprehensive benefits plan that includes the following: Paid holidays, vacation and sick leave, vision, dental and medical health plans, employer paid life insurance, 401k with company match, direct deposit, and employee assistance program Responsibilities: Review clinical information for appropriateness, congruency, and accuracy as it relates to the OASIS and ICD 10 coding while using the Medicare PDGM billing model and CMS guidelines. Review and communicate OASIS edit recommendations to each clinician to promote OASIS accuracy. Perform final review and lock OASIS. Timely review and coding of OASIS documents with productivity maintained at the quarterly target set by the Director of MCM. Prevent or decrease the occasion of Medicare denials by assuring proper coding on the plan of care and accurate OASIS documentation. Provide support and communication to all disciplines within the service. Provide customer service/education and act as a resource to Medicare Certified Offices with regards to CMS guidelines, Home Care Coding, PDGM guidelines and billing related issues. Provide ongoing communication with service offices via e-mail, zoom, or telephone (specific to the service office needs). Communication with service offices monthly and as appropriate with a focus on documentation trends, star ratings and potential revenue impact. Perform related duties, or as required or requested by Manager/Director. Qualifications: Competency in PC skills required to perform job function Active State RN Nursing License, Physical (PT), Occupational (OT) or Speech (SLP) Therapists with required certifications with a minimum of 2 years clinical experience. Please note, while this is a clinical opening, BAYADA does have non-clinical openings available COS-C or HCS-O or COQS OASIS Certification and experience required BCHH-C or HCS-D Home Health Care Coding Certification and experience required HCHB, SHP, and Coding Center experience, a plus! Be part of a caring, professional team that is instrumental in providing the highest quality care while developing your career with an industry leader. Apply now for immediate consideration. OASIS Review, Utilization Review, Quality Assurance, Remote, Home Health Coding, Coder, Medicare As an accredited, regulated, certified, and licensed home health care provider, BAYADA complies with all state/local mandates. BAYADA is celebrating 50 years of compassion, excellence, and reliability. Learn more about our 50th anniversary celebration and how you can join in here. BAYADA Home Health Care, Inc., and its associated entities and joint venture partners, are Equal Opportunity Employers. All employment decisions are made on a non-discriminatory basis without regard to sex, race, color, age, disability, pregnancy or maternity, sexual orientation, gender identity, citizenship status, military status, or any other similarly protected status in accordance with federal, state and local laws. Hence, we strongly encourage applications from people with these identities or who are members of other marginalized communities.

Utilization Review Clinician - Behavioral Health

Centene IA

$27.02 - $48.55 / hour

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. **** NOTE: This fully remote role supports utilization management and quality improvement efforts by identifying outlier provider performance, conducting comprehensive clinical record reviews, and delivering individualized coaching to providers. The position also synthesizes findings into clear, actionable presentations for providers and health plan leadership. Preference will be given to applicants who (1) reside in either central or eastern time zone with (2) experience in mental health settings, (3) utilization management / review, as well as (4) applicants who are presenting to leadership/providers and advising providers on performance. **** Additional Details: • Department: BH Utilization Mgmt. – Partnerships in Care • Business Unit: Corporate • Schedule: Monday through Friday 8-5 PM CT or ET with 1 hour lunch Position Purpose: Performs a clinical review and assesses care related to mental health and substance abuse. Monitors and determines if level of care and services related to mental health and substance abuse are medically appropriate. Evaluates member’s treatment for mental health and substance abuse before, during, and after services to ensure level of care and services are medically appropriate Performs prior authorization reviews related to mental health and substance abuse to determine medical appropriateness in accordance with regulatory guidelines and criteria Performs concurrent review of behavioral health (BH) inpatient to determine overall health of member, treatment needs, and discharge planning Analyzes BH member data to improve quality and appropriate utilization of services Provides education to providers members and their families regrading BH utilization process Interacts with BH healthcare providers as appropriate to discuss level of care and/or services Engages with medical directors and leadership to improve the quality and efficiency of care Formulates and presents cases in staffing and integrated rounds Performs other duties as assigned. Complies with all policies and standards. Education/Experience: Requires Graduate of an Accredited School Nursing or Bachelor's degree and 2 – 4 years of related experience. License to practice independently, and/or have obtained the state required licensure as outlined by the applicable state required. Master’s degree for behavioral health clinicians required. Clinical knowledge and ability to review and/or assess treatment plans related to mental health and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and healthcare teams to review care services related to mental health and substance abuse preferred. License/Certification: LCSW- License Clinical Social Worker required or LMHC-Licensed Mental Health Counselor required or LPC-Licensed Professional Counselor required or Licensed Marital and Family Therapist (LMFT) required or Licensed Mental Health Professional (LMHP) required or RN - Registered Nurse - State Licensure and/or Compact State Licensure required Pay Range: $27.02 - $48.55 per hour Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act