Christy Merriman

Centerwell Home Health | Cheraw, SC

Clinical Manager - Quality Assurance

01/2016 - Current

• Centerwell Home Health | Cheraw, SC

Clinical Manager - Quality Assurance

01/2016 - Current

• Reviews case referrals. Reviews patient information related to case including disciplines required, to determine home health needs. Accountable to ensure patients meet admission criteria and makes the decision to admit patient to service.

• Monitors cases to ensure documentation follows regulatory agencies and requirements of third-party payers. Ensures final audits/billing are completed timely and in compliance with Medicare regulations.

• Reviews Plans of Care for validity and appropriateness of care before sending to physicians and insurances.

• Participates in sales and marketing initiatives.

• Participates in interviewing, hiring, training and development of direct care clinicians.

• Provides Utilization Review of staff and processes relative to data tracking for performance review and outcomes of care analysis to determine efficiency, efficacy of case management system as well as other systems and processes.

• Provides performance improvement activities, maintains ongoing clinical knowledge through internal and external training programs. Provides interpretation of knowledge and direction to staff.

• Organizes Utilization Review team to analyze our deficits and progress identified according to Medicare guidelines using SHP reporting program and Oasis assessments. Upon completion, provide staff education in these critical areas.

• Conducts /delegates the assessment/reassessment of patients, including updating of care plans and interpreting patient needs, while adhering to Company, physician, and / or health facility procedures/ policies.

• Instructs and guides clinicians to promote more effective performance and delivery of quality home care service and is always available to assist clinicians.

• Coordinates communication between team members, attending physicians, and caregivers to ensure the appropriateness of care and outcome planning.

• Analyzes situations, identifies problems, identifies, and evaluates alternative courses of action through utilization of Performance Improvement principles.

• Developed care plans, covering goals based on nursing diagnosis and incorporating therapeutic, preventive, and rehabilitative nursing actions.

• Notified physicians of all changes in patients' conditions.

• Utilized learned nursing skills for wound care, vital sign checking, drains, wound vacs, IV medication administration and medication assistance.

• Provided home health aide care providers with training, guidance, support, and supervision to achieve objectives.

• Administered compassionate care to patients with debilitating conditions, including back pain, arthritis, fractures, head injuries, strokes. Also managed and educated patients with conditions such COPD/CHF on exacerbation prevention.

• Worked with vendors on provision of medical equipment, supplies, and services.

• Conducted regular re-evaluations to address changes in needs and conditions, introducing revisions to care plans as needed.

• Completed initial assessments of patients and family to determine and address individual home care needs.