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Episode Management Consulting Supervisor

extra holidays - extra parental leave

Remote:

Full Remote

Contract:

Full time

Experience:

Mid-level (2-5 years)

Work from:

United States

Offer summary

Qualifications:

Associate’s degree in nursing or related discipline, Active and unrestricted license in related field, 2 years experience in home health quality assurance, 2 years progressive home health clinical management experience, In-depth knowledge of CoPs, OASIS, and Episode Management.

Key responsabilities:

Conduct weekly calls with clients for review findings
Analyze trends to provide recommendations for operational processes
Perform Medicare pre-bill reviews for compliance
Prepare and present project progress reports to client leadership
Research and make comments on identified risk periods

Netsmart Large https://www.ntst.com/

1001 - 5000 Employees

See more Netsmart offers

Job description

Responsible for providing clinical expertise in working with clients and internal operational experts focused on the home health and hospice sectors

Responsibilities

Conduct weekly location calls with the client to review findings from a review of open and closed period
Research and provide comments and recommendations on identified at-risk periods of care as per engagement requirements
Review client EHR for clinical documentation
Recommend home health visits based on clinical documentation and interaction with the client
Present weekly project progress reports to client leadership
Prepare and present monthly project progress to client leadership
Review client EHR for clinical documentation
Research and provide comments and recommendations on newly issued or highly complex cases related to potential Low Utilization Payment Adjustments (LUPAs) or potential overutilization
Analyze trends and provide recommendations for home health operational processes to improve quality of care and patient outcomes
Identify opportunities to deliver strategies to improve individual client health and overall experience
Drive continuous improvement efforts internally and on client-specific engagements
Perform Medicare home health pre-bill reviews for compliance with regulations prior to claim submission. Write appeals for denied home health services
Participate in cross team clinical consulting work including Medicare home health clinical compliance documentation reviews including but not limited to focused medical reviews related to ADR, RAC, ZPIC, UPIC, etc. as needed

Qualifications

Required

Associate’s degree in nursing, physical therapy, occupational therapy or another related discipline
Active and unrestricted license in related field 
At least 2 years of experience in home health quality assurance and performance improvement
At least 2 years of progressive home health clinical management experience
At least 1 year  case management, concurrent review or utilization management work experience
In-depth knowledge of conditions of participation (CoPs) and conditions of payment for Home Health, extensive knowledge of OASIS and Episode Management
Proficiency in Microsoft Office Suite including Excel, PowerPoint, and Word
Excellent written and oral communication and presentation skills are required

Preferred

Bachelor of Science in nursing (BSN), Physical Therapy, or Occupational Therapy

Expectations

Potential travel up to 25% of the time as needed
Position may at times require extended or irregular hours outside of traditional office hours to support clients and projects across multiple time zones and any required travel

Netsmart is proud to be an equal opportunity workplace and is an affirmative action employer, providing equal employment and advancement opportunities to all individuals. We celebrate diversity and are committed to creating an inclusive environment for all associates. All employment decisions at Netsmart, including but not limited to recruiting, hiring, promotion and transfer, are based on performance, qualifications, abilities, education and experience. Netsmart does not discriminate in employment opportunities or practices based on race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, national origin, age, physical or mental disability, past or present military service, or any other status protected by the laws or regulations in the locations where we operate.

Netsmart desires to provide a healthy and safe workplace and, as a government contractor, Netsmart is committed to maintaining a drug-free workplace in accordance with applicable federal law. Pursuant to Netsmart policy, all post-offer candidates are required to successfully complete a pre-employment background check, including a drug screen, which is provided at Netsmart’s sole expense. In the event a candidate tests positive for a controlled substance, Netsmart will rescind the offer of employment unless the individual can provide proof of valid prescription to Netsmart’s third party screening provider.

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All applicants for employment must be legally authorized to work in the United States. Netsmart does not provide work visa sponsorship for this position.

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