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RN (Clinic/Home)
Ref No.: 17-02645
Location: Glen Allen, Virginia
Start Date / End Date: 05/02/2017 to 12/31/2017
4191 Innslake Dr. Glen Allen VA 23060 Max Bill rate = $39.20 Our Program offers person-centered care planning, service coordination and self-supported care services for members receiving long-term care (LTC) and home and community (HCBS) services. The LTSS Quality Reviewer (LQR) is responsible for performing field-based programmatic evaluation and contractual adherence to ensure LTSS Care/Case Manager/Coordinators are facilitating, promoting and advocating for the member’s ongoing self-sufficiency, independence and policy and procedure adherence. The LQR will conduct field-based ride along reviews in observance of LTSS CM/CC’s conducting face-to-face and/or telephonic assessments to assess the member’s need for supported self-care to alleviate functional deficits. The LQR conducts triangulation reviews to ensure congruency between the: 1. Plan of Care; 2. Authorizations; and, 3. Paid claims. The LQR adheres to the Annual LTSS Quality Review Schedule. LTSS Quality Reviewer Functions As a LTSS Quality Reviewer you will be primarily responsible to critically evaluate: a. Process completeness and contractual adherence of member visits; b. Programmatic policy and procedural adherence; and, c. Review clinical quality of face-to-face and telephonic assessments and interventions with members/care givers and appropriate associated documentation. The focus is to identify the purpose/goal of interaction, use of motivational interviewing techniques in supporting member needs and in promoting CM driven/ member supported self-care at the most appropriate level of care, Plan of Care (POC).