Quality Review Specialist

• Chart/Record Audits:Review patient medical records and documentation for accuracy, completeness, and compliance with internal policies and external regulations (CMS, OASIS guidance, state and federal laws).

• Performance Monitoring:Track and analyze key performance indicators (KPIs), including patient outcomes, readmission rates, medication errors, and adherence to care plans and oasis guidance.

• Compliance Oversight:Ensure compliance with healthcare standards, policies, and all regulatory requirements.

• Staff Education & Feedback:Provide constructive feedback and training to clinical staff regarding documentation practices, quality standards, and opportunities for improvement.

• Quality Improvement:Identify trends, gaps, and risks in care delivery; collaborate with leadership to develop and implement corrective action plans.

• Patient Safety:Monitor for patient safety concerns, adverse events, or near misses, and ensure timely reporting and resolution.

• Data Analysis & Reporting:Collect, interpret, and present data to leadership, committees, and regulatory bodies to support continuous improvement.

Skills & Qualifications

• Strong knowledge of healthcare regulations, accreditation standards, and quality improvement methodologies (e.g., Lean, Six Sigma, QAPI certified).

• Background in nursing, healthcare administration, or health information management. (But will also accept PT, OT, SLP, MDS)

• Exceptional attention to detail with strong analytical and problem-solving skills.

• Excellent written and verbal communication skills with the ability to provide feedback and training to staff.

• Ability to collaborate effectively with interdisciplinary teams (nurses, physicians, administrators).

Education

• High school diploma or GED required; Associate's degree preferred.

• OASIS and Coding certification required.

Experience

• Minimum of two years of experience in home care (or experience completing oasis assessments in E or E1).

• Strong background in assessments, clinical documentation, and coding.
• ICD-10coding experience is a plus

Additional Requirements

• Communication & Interpersonal Skills:Must demonstrate excellent communication, comprehension, and interpersonal abilities. Proficiency in reading, writing, and speaking English is required.

• Technical Skills:Proficiency with Microsoft Office Suite (Word, Excel, Outlook, PowerPoint) and Windows-based applications. Ability to quickly learn and adapt to new software systems.

• Professional Skills:Highly organized, self-directed, and capable of managing multiple priorities. Strong motivational skills with high emotional intelligence (EQ).

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