Clinical Central Review Associate

The posting, as BAYADA Home Health Care wrote it

POSITION SUMMARY

Responsible to learn all aspects of clinical management under the guidance of the Clinical Manager / Rehabilitation Manager and the Director.

MINIMUM QUALIFICATIONS

• Exemplifies characteristics of The BAYADA Way: compassion, excellence, and reliability.
• Holds a current license in good standing as a Registered Nurse. PT, OT, or ST. BSN / Master’s preferred and required based on state regulations.
• Graduate of an accredited and approved nursing program.
• Demonstrated record of strong interpersonal skills.
• Demonstrated record of goal achievement.
• Demonstrated ambition to taking on more responsibility and grow past current position.
• Achieves a passing score on the appropriate nursing quiz and all required competency tests appropriate to the type of cases that they will be supervising.
• Demonstrated knowledge of the Medicare Conditions of Participation and other program requirements.
• Completed Nursing Skills Checklist demonstrating knowledge and skills appropriate to age range of client population.
• Completed criminal background and federal/state program exclusions checks.
• Completed Continuing Education Requirements (CEUs) as required by regulation.

PRIMARY RESPONSIBILITIES

• Demonstrate and communicate the core values of BAYADA Home Health Care and The BAYADA Way.
• Participate in the oversight of the delivery of all services to ensure superior quality, under guidance of the Clinical Manager / Rehabilitation Manager.
• Review all clinical documentation to ensure consistent, accurate, high-quality services.
• Work with MCM to ensure accurate ICD coding.
• Monitor episodic utilization to ensure care is being delivered according to consistent protocols.
• Work with other office team members to ensure that the most appropriate clinicians are assigned to each client.
• Ensure that all documentation progresses efficiently through each stage of the care delivery process, from start of care to discharge.
• Work with the field staff to ensure accurate and timely case management, including HHA and LPN supervision, authorization management, and interdisciplinary communication.
• Coordinate the delivery of medical supplies with MCO and MCM.
• Act as internal case manager and client advocate. Communicate and collaborate with team members regarding client status, care plan and expected outcomes.
• Participate in the Infection Control Program by identifying and reporting infections and risks. Conduct investigation for infection trends and practice issues. Develop an action plan for improvement as needed.
• Work with the office staff team to respond to ADRs and denials.
• Assist Clinical Manager / Rehabilitation Manager in providing clinical oversight to field staff.
• Participate in the hiring of field staff and interview process, as applicable.
• Observe and confirm the competency of field staff.
• Participate in new hire orientations

[…]
standards in key job dimensions/attributes as defined on the Performance Appraisal for Office Staff.

• Perform related duties as required or requested by supervisor:
• Transition into Clinical Manager I role under direct guidance of Clinical Manager Mentor.

OTHER RESPONSIBILITIES

• Together with entire office staff, answer phones, greet visitors and generate correspondence as necessary for office needs.
• Maintain current knowledge of, and follow standards of practice, BAYADA policies and procedures, and regulations (government, contract, accrediting body).
• Strive continually for professional growth and development through continuing education and/or organizational membership.

BAYADA believes our employees are our greatest asset

• Base Salary: $75,000 - $85,000 / year depending on qualifications
• Bonus Opportunity available
• BAYADA offers a comprehensive benefits plan that includes the following: Paid holidays, vacation and sick leave, vision, dental and medical health plans, employer paid life insurance, 401k with company match, direct deposit and employee assistance program
• To learn more about BAYADA Benefits, click here

As an accredited, regulated, certified, and licensed home health care provider, BAYADA complies with all state/local mandates.

BAYADA is celebrating 50 years of compassion, excellence, and reliability. Learn more about our 50th anniversary celebration and how you can join in here .

BAYADA Home Health Care, Inc., and its associated entities and joint venture partners, are Equal Opportunity Employers. All employment decisions are made on a non-discriminatory basis without regard to sex, race, color, age, disability, pregnancy or maternity, sexual orientation, gender identity, citizenship status, military status, or any other similarly protected status in accordance with federal, state and local laws. Hence, we strongly encourage applications from people with these identities or who are members of other marginalized communities.