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Clinical Outcome Reimbursement Specialist-RN

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Job ID: 165656
Category: Nursing
Work Type: FT
Location: Bala Cynwyd, PA, United States
Work Schedule: M-F, Day

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Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines.

Today at Penn Medicine, someone will make a breakthrough. Someone will heal a heart, deliver hopeful news, and give comfort and reassurance. Our employees shape our future each day. Are you living your life's work?

Penn Medicine at Home is currently hiring for the Clinical Outcome Reimbursement Specialist at the RN level and OASIS and Coding Certifications highly preferred.


The Clinical Outcome and Reimbursement Specialist is responsible for collaborating with clinicians at established points in time to assure accurate completion of assessments and development of effective plans of care to assure appropriate utilization and promote appropriate quality patient care and positive patient outcomes.


  • Assures accuracy of assessment documentation and development of effective Plans of Care (485’s): Reviews all Medicare/Managed Care admissions for appropriateness; Ensures referred clients meet home care admission requirements; Reviews clinical assessments with clinical staff assigned to the client and determines needs; Analyzes OASIS data to ensure accuracy of data; Reviews reliability of functional score; Collaborates with clinicians on the development of plans of cares; Reviews and assigns ICD-10 codes in correct order; Reviews all utilization orders and POTs for assigned clients; Documents visit frequency according to agency guidelines.
  • Ensures ongoing proper utilization of resources: Manages all PPS events for assigned Medicare patients (Resumptions, Recerts); Assures appropriate utilization of resources for the managed care patients; Notifies department or team managers regarding potential negative variances; Utilizes decision support system (SHP) and alerts to manage workflow; Advises staff regarding the need for SCIC assessments if changes in condition; Reviews and collaborates with clinician on any variation from the POC and authorized visits; Upon discussion with clinical staff, approves discharges as indicated.
  • Collaborates with clinical staff, clinical supervisors and managers to facilitate care planning at all points within the client’s admission: Serves as a resource to therapist peers with regards to clinical assessment of clients and the need for nursing and social work interventions; Identifies cases for interdisciplinary case conferences for assigned team(s) and attends as indicated; Participates in recertification conferencing as needed.
  • Collaborates with the clinical supervisors/managers in the education process for clinical staff: Communicates staff performance issues to Department Manager; Performs joint home visits with staff requiring additional education, new hires and high risk cases related to assure OASIS competency; Participates in department and team meetings to provide education to staff on changes in OASIS or Managed Care processes.
  • Proficient use of Home Care Information System and Decision Support software: Utilizes information systems to document all actions taken regarding patients’ care; Prepares, distributes and presents reports related to utilization of care and clinical outcomes as needed; Runs key agency reports to track referrals through the admission process; Utilizes decision support software to calculate HHRG scores and to monitor inconsistencies in the patients’ functional score.
  • Performs duties in accordance with Penn Medicine and entity values, policies, and procedures.
  • Other duties as assigned to support the unit, department, entity, and health system organization


  • LPN-PA and/or NJ (Required)
  • Bachelor's degree from CAPTE accredited school of physical therapy
  • Licensed to practice physical therapy in the state of Pennsylvania and/or New Jersey
  • HCS-D Certification (or must be obtained within 1 year of employment)
  • COS-C Certification or HCS-O Certification (or must be obtained within 1 year of employment)

Education or Equivalent Experience:

  • Diploma or ASN from an accredited school of nursing. If a Physical Therapist, must have a minimum of a Bachelor's in Physical Therapy from an accredited school of physical therapy and 2+ years' experience in Medicare regulations for OASIS, compliance, and coding an/or experience in the home care criteria and processes related to managed care.
  • BSN from an accredited school of nursing or a Bachelor's in Physical Therapy from an accredited school of physical therapy and 2+ years' experience in Medicare regulations for OASIS, compliance, and coding an/or experience in the home care criteria and processes related to managed care.
We believe that the best care for our patients starts with the best care for our employees. Our employee benefits programs help our employees get healthy and stay healthy. We offer a comprehensive compensation and benefits program that includes one of the finest prepaid tuition assistance programs in the region. Penn Medicine employees are actively engaged and committed to our mission. Together we will continue to make medical advances that help people live longer, healthier lives.

Live Your Life's Work

We are an Equal Opportunity and Affirmative Action employer. Candidates are considered for employment without regard to race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran or any other status protected by applicable law.

   Current UPHS employees must apply HERE
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