Optum ยท 16 hours ago
Quality Review Specialist
Lafayette, LA
Full-time
Onsite
Entry, Mid Level
$71K/yr - $127K/yr
1+ years expOptum is part of LHC Group, a leading post-acute care partner dedicated to helping people feel their best. The Quality Review Specialist is responsible for reviewing medical records and OASIS assessments to ensure accuracy and compliance with guidelines, while also engaging with clinicians to improve documentation practices.
EducationHealth CareMedicalPharmaceutical
Responsibilities
Thoroughly reviews the medical record as part of the OASIS review process and recommends the most accurate codes, adhering to official OASIS guidelines as approved by the Centers of Medicare and Medicaid Services (CMS)
Reviews plan of care; recommends edits to clinician and makes edits to the plan of care based on updated provider orders
Consistently engages directly with clinicians to improve accuracy of OASIS assessments, ensure proper development of the plan of care relevant to the primary focus of care and the patient assessment, and assure clinically appropriate discharges
Assesses clinical documentation to ensure that it supports the recommended OASIS and POC changes
Consults the clinician for clarification, via electronic alerts, when conflicting or ambiguous documentation is present, and abides by the clinician's acceptance or declination of changes
Provides OASIS education to clinicians when opportunities arise (e.g., provide pertinent official OASIS guidelines or conventions when the clinician questions a change recommendation)
Maintains accurate and timely review of OASIS time points and all related interdisciplinary documentation via the workflow in the electronic medical record (EMR) for timely OASIS locks and submission to the Centers for Medicare and Medicaid (CMS)
Develops and implements training based on evaluated competencies in documentation and clinical practice, edits from Strategic Healthcare Programs (SHP) alerts, and SHP reports for specific outcomes, adverse events, and utilization reports in conjunction with the OASIS Analyst, Clinical Director (CD), Executive Director (ED), or PI Coordinator
Collaborates with regional PI coordinator and agency to facilitate initiatives to improve quality outcomes and agency ratings
Identifies educational trends for agency and/or per clinician and discusses with Clinical Director and Quality Review Supervisor to further train/educate staff and improve OASIS accuracy. Reports to supervisor and operational leadership any continued lack of improvement or engagement from clinicians
QR Specialist may be required to relocate to a nearby office and perform PCM workflow occasionally
QR specialist will continue to participate in on-call rotation for their originating agency if they were in the on-call rotation prior to QR role
Qualification
Required
Current CPR certification
Current Driver's License, vehicle insurance, and access to a dependable vehicle or public transportation
Current and unrestrictive RN, PT, ST, or OT licensure in state of practice
Current COS-C or completion within 90 days of position effective date
1+ years of Home Health experience as RN, PT, ST, or OT
Ability to analyze OASIS data at a high level, and to accurately interpret and apply current OASIS guidelines, Conditions of Participation, and PPS guidelines to find opportunities for training and development
Preferred
Effective verbal and written communication skills
Solid computer skills with proven ability to use MS Office applications, OASIS review software, and clinical documentation software as well as reports available in these programs
Exceptional organizational skills
Benefits
Comprehensive benefits package
Incentive and recognition programs
Equity stock purchase
401k contribution
Company
Optum
Optum is a healthcare company that provides pharmacy services, health care operations, and population health management. It is a sub-organization of UnitedHealth Group.
10001+ employees
H1B Sponsorship
Optum has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (506)
2024 (559)
2023 (620)
2022 (851)
2021 (593)
2020 (438)
Funding
Current Stage
Late StageLeadership Team
Daniel Castillo
Chief Executive Officer, Optum Care Delivery
J
Jay Green
Chief Financial Officer
Recent News
2025-11-29
2025-11-19
2025-11-07
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