Teams at Nascentia Health

Perform QA audits of CHHA and LHCSA clinical records (including OASIS and coding), analyze documentation trends, coach clinicians, follow up on deficiencies, support performance improvement projects, maintain regulatory knowledge (Medicare/Medicaid), and collaborate with interdisciplinary teams to improve patient outcomes and compliance.

Provides on-site RN care coordination for health plan members in a skilled nursing facility. Responsibilities include clinical surveillance, patient assessment, care-plan development, telehealth facilitation, provider and interdisciplinary coordination, transitions of care, utilization review, quality improvement, authorization reviews, member education, and regulatory compliance. The coordinator also analyzes utilization data, supports ISNP Model of Care implementation, and advocates for patients and families.

Supports health plan members, providers, and third-party adjudicators with claims, billing, benefits, eligibility, authorization, and payment inquiries for Medicaid and Medicare plans. Reviews claims, resolves adjudication issues, documents findings, collaborates with departments and vendors, and provides customer service while maintaining HIPAA and privacy compliance.