Oasis Medicare Review Coordinator

Overview

Presbyterian Homes & Services, Optage Home Home Care is seeking a full time OMR (Oasis Medicare Review) Coordinator to join its team.  This role is responsible for overseeing the client assessment process for 400+ home care clients, and for coordinating with 30+ health professionals.

Schedule: This is 40 hours/week during normal business hours.

Location: This position is on-site/in-person in Roseville, MN.

Responsibilities

The OMR Coordinator is responsible for coordinating and overseeing the development and completion of the client assessment process consistent with regulations and established clinical best practices across Optage Home Care.

Position Responsibilities include, but are not limited to:

• Direct and ensure the development and completion of the OASIS client assessment process with other health professionals consistent with regulations and established clinical best practices. Ensure timely, accurate and complete assessment of the client’s health and functional status during the entire assessment period. Other specific areas of responsibility include but are not limited to:
• Maintain an accurate schedule and assignments of all Oasis assessments to include the proper reference dates throughout the client’s stay. Coordinate schedule/F2F date. Conduct assessments as needed.
• Maintain the frequent and accurate data entry of client information into appropriate computerized OM programs. Manage Oasis and coding submissions.
• Audit HHCAHPS and review all expedited appeals. Perform concurrent Oasis review to assure appropriate Case Mix category is achieved through the capture of appropriate clinical information.
• Perform monthly QI/QM review and provide recommendations to IDT and Case Managers.
• Determine denials/communications at IDT, track clients in 30 day window, monitoring regulatory compliance for completion.
• Transmit, review, validate reports and communicate problem areas for correction to Clinical Supervisor team and Home Care Administrator. 
• Capture custodial vs skilled care assessment. 
• Include ICD10 DX prioritization.
• Ensure F2F compliance documentation in each 485 clinical record.
• Ensure the development of the written plan of care for each client based on the client assessment. 
• Participate in the interdisciplinary team process (IDT) to communicate opportunities, facilitate efficient and effective care plan development and management. Collaborate with the interdisciplinary team to identify significant change in Oasis scoring and educate the team on best practice. Specifically communicate (but not limited to): Oasis C2 changes and scoring, changes to skilled services, ADR readiness and F2F clinical documentation to support skilled and medically necessary need, significant change in status assessments.
• Develop, implement and maintain established policies, procedures and practices related to the development, use and implementation of the client assessment (Oasis) and care plan. Ensure policies and procedures are understood and implemented by staff. Use the quality management process to assure accurate completion of client assessments, care plans and care delivery processes. Maintain all required documentation in accordance with regulations and established clinical best practices.
• Audit client records and supporting documentation to include data analysis, evaluation and communication of audit findings. Conduct regular audit of OMR process including validation of coding documentation, and evaluating outcomes per policy. Maintain monitoring systems and processes to ensure compliance with regulations and established clinical best practices. Responsible for key measure management.
• Lead the OMR/F2F process and staff to ensure high quality care and service for clients (physical, mental, emotional, social and spiritual) and maintains their independence and dignity to the highest degree possible. Establish and maintain effective communication systems with all case managers.
• Assist in providing employee training related to the client assessment process. Train and support the performance of the Optage Case Managers and other health with respect to client assessments and OASIS completion. Coach and assist staff to achieve desired outcomes and individual development.

Qualifications

• Registered nurse with current licensure with the State Board of Nursing in state(s) in which he/she practices

• OASIS Certification preferred

• Previous home care experience with a working knowledge of the Oasis process.

• Experience with Oasis completion, reimbursement coding and clinical resource utilization and/or case management.

• Ability to work flexible work hours to support business requirements.

• Competency with standard office software applications as well as software applications related to F2F/Oasis processes.

• High initiative and ability to efficiently and effectively lead interdisciplinary teams and coordinate and manage OMR process.

• Demonstrated compatibility with PHS' mission and operating philosophies.

• Demonstrated ability to read, write, speak and understand the English language to communicate with all customers.

Pay Range

The estimated starting pay range for this role is $74,194 - $92,747 per year. This good faith estimate is based upon PHS’s typical starting pay range for this role. Actual pay range depends upon many factors including each individual employee’s qualifications and market conditions and is subject to change.

Benefits

Full-time benefits-eligible employment begins at a minimum of 30 hours per week:

• Health, and dental, including applicable HSA & FSA
• Employer Contribution to HSA for eligible Health Plans
• Life insurance (AD&D)
• Retirement, with eligibility for an employer match
• Holiday pay and extended sick

Full and Part-time benefits-eligible employment working between 20-29 hours per week:

• Vision insurance
• Voluntary short-term & long-term disability
• Accident & hospitalization coverage
• Education assistance programs

All employees:

• Accrue PTO (Paid time off)
• Same-day pay
• Employee assistance program (EAP)
• College partnership educational discounts
• Access to Learn to Live Resources

About PHS

Presbyterian Homes & Services (PHS), based in St. Paul, Minnesota, is a nonprofit, faith-based organization providing a broad array of high-quality housing choices, care and services options for older adults. Some 8,000 employees serve more than 41,800 older adults through 60 PHS-affiliated senior living communities in Minnesota, Iowa and Wisconsin, and through Optage® home and community services. PHS is also co-owner of Genevive, the largest geriatric primary care practice in Minnesota, providing comprehensive care for more than 15,500 older adults. Established in 1955, PHS has earned the reputation as an innovative leader dedicated to promoting independence, purposeful living and the overall well-being for those they serve. Today, PHS is one of the largest nonprofit providers of senior housing and services in the nation.

PHS is an EEO/AA employer. All applicants will receive consideration for employment regardless of their race, color, creed, religion, national origin, sex, sexual orientation, disability, age, marital status, or status with regard to public assistance.