Netsmart
A healthcare software company helping you deliver whole-person, value-based care.
Clinical Consulting Manager, PRN
Location
United States
Posted
8 days ago
Salary
Not specified
Associate Degree5 yrs expEnglish
Job Description
• Perform documentation review on medical records to identify clinical elements for accuracy
• Perform post-acute home health and or hospice documentation review on medical records to identify clinical elements for accuracy
• Research and provide comments and recommendations on complex or newly issued home health and or hospice billing regulations
• Review client information systems for complete and accurate clinical documentation
• Research and provide comments and recommendations on complex or newly issued billing regulations
• Conduct weekly calls with the client to present findings and results of the engagement
• Analyze trends and provide process improvement recommendations for clinical operational processes to improve quality of care and patient outcomes
• Review documentation associated with focused medical reviews and write appeals for denied services; provide denial support at the Administrative Law Judge (ALJ) level of appeals
• Participate in cross-team clinical consulting work
Job Requirements
- Associate’s Degree in nursing, social work, physical therapy or another related discipline
- Active and unrestricted license in related field
- At least 5 years of progressive clinical management experience
- At least 2 years case management in home health and/or hospice with progressive experience in Quality Assurance activities
- In-depth knowledge of condition of participations and conditions of payment; extensive knowledge of regulatory standardized assessment documents and patient care protocols
- Proficient in Microsoft Office Suite including Excel, PowerPoint, and Word
- Excellent written and verbal communication and presentation skills are required
Benefits
- Netsmart is proud to be an equal opportunity workplace
- Affirmative action employer
- Equal employment opportunities to all individuals
- Celebrate diversity and committed to creating an inclusive environment
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