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PIH Health is a nonprofit, regional healthcare network that serves approximately 3 million residents in the Los Angeles County, Orange County and San Gabriel Valley region. The fully integrated network is comprised of PIH Health Hospital - Whittier, PIH Health Hospital - Downey and PIH Health Good Samaritan Hospital, 27 outpatient medical locations, a multispecialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer, women’s health, urgent care and emergency services. The organization is recognized by Watson Health as one of the nation’s Top Hospitals, and College of Healthcare Information Management Executives (CHIME) as one of the nation’s top hospital systems for best practices, cutting-edge advancements, quality of care and healthcare technology. PIH Health is certified as a Great Place to Work ^TM.

Performs comprehensive review of the Home Health and Hospice Prospective Payment System, including the Outcome and Assessment Information Set (OASIS), Home Health Plan of Care and Strategic Healthcare Programs (SHP) results, and Hospice Item Set (HIS) at the highest level of accuracy and productivity. Presents the findings and recommendations to the staff at all levels as well as senior management. Able to perform utilization review of the Electronic Health Record (EHR) for current and discharged patients.  

The Quality Assurance/Utilization Review Registered Nurse (RN) will verify appropriate documentation, compliance, quality of care provided, ensure adherence to the plan of care, and identify document deficiency trends in a proactive approach. The Quality Assurance/Utilization Review RN will serve as a role model, consultant, auditor and OASIS/HIS expert to staff in PIH Health Home Health and Hospice auditing charts for clinical oversight and compliance and adherence to the Medicare guidelines. The Quality Assurance/Utilization Review RN is responsible for continuous assessment of agency processes to insure compliance with government regulations/accreditation standards, acts as a resource to the home care clinicians and the leadership team regarding standards, policies, and regulations.

• Knowledgeable about how to complete an accurate OASIS, Plan of Care and review SHP results
• Experience with OASIS Assessments, all related documentation and regulatory standards for documentation
• Demonstrated expertise in interdisciplinary Home Health care for patients of all ages, and in the clinical process (assessment, plan, implementation and evaluation)Familiarity with California State laws, regulations and standards governing Home Health care, including Community Health Accreditation Partner (CHAP) standards of excellence for Home Health, and with tools for evaluating Home Health care, including Medicare Conditions of Participation and Title 22
• Knowledge of EHR application
• Must have strong organizational and analytical skills
• Able to meet commitments and deadlines
• Must be proactive, detail-oriented, and able to work with minimal supervision
• Able to work well under pressure
• Demonstrated ability to coach and mentor new staff
• Excellent coordination and communication skills.

Required:

• Current California Registered Nurse license
• Bachelor of Science in Nursing
• One (1) to two (2) years of clinical home health experience
• Intermediate computer skills including Microsoft Outlook, Excel, Word, PowerPoint. Willingness to learn new information technology
• Current California State Driver's license and automobile insurance

Preferred:

• Master of Science in Nursing
• Experience in Quality Assurance and Utilization Review
• Experience with HIS assessments
• Previous coaching experience
• Working knowledge of OASIS and ICD-10 coding
• OASIS certification (COS-C)
• OASIS Home Health ICD-10 coding certification

For more information, visit PIHHealth.org or follow us on Facebook, Twitter, or Instagram.

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About PIH Health

PIH Health is the Communities’ Health and Wellness Partner Our network of highly trained and compassionate physicians, nurses, clinicians, staff and volunteers work tirelessly and collaboratively every day to maintain and enhance the health and wellbeing of every member of our service areas. And when needed, we are here to coordinate care, manage chronic disease, and treat health conditions for the best possible outcomes. We’re a nonprofit, regional healthcare network with three hospitals, numerous outpatient medical offices, a multispecialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer, digestive health, orthopedics, women’s health, urgent care and emergency services. Our leadership is dedicated to putting patients first—a cornerstone of our mission, vision and values—as we deliver top-quality healthcare. We serve more than 3.7 million residents in the Los Angeles County, Orange County and San Gabriel Valley region. Why PIH Health? Our culture is built around our core values, which are the guiding principles for everything we do. For over 60 years, PIH Health has maintained a sense of community and a family-like cultur...e where patients are the top priority, and employees and volunteers are proud to be affiliated with such an outstanding organization. PIH Health Hospital - Whittier Our Whittier campus delivers outstanding and compassionate care to patients, every day. Among other awards, PIH Health Hospital - Whittier has been named one of the nation’s 100 Top Hospitals® for the third consecutive year by Truven Health Analytics. PIH Health Hospital in Whittier, CA is located 30 minutes east of Los Angeles, close to the Los Angeles and Orange County border. There are many great communities in which to live that surround the hospital. This means easy access to work, great dining, shopping, entertainment and spectacular beaches. Whatever your passion, you’ll find the right place for it here. PIH Health Hospital - Downey is a nonprofit hospital with a rich, nearly 100-year history of meeting the healthcare needs of its community. The Downey campus is part of the PIH Health comprehensive health network consisting of two hospitals, 18 medical office locations and a host of specialty services. According to US News & World Report, the hospital scores highly in patient safety and orthopedics. With 955 employees, the hospital is the 5th largest employer in the city of Downey.

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